Quantitative sonographic feature analysis of clinical infant hypoxia: a pilot study.

PURPOSE: To determine whether textural features derived from sonographic pixel intensities differ significantly between healthy infants and infants who have had acute clinical hypoxic episodes. METHODS: Neurosonographic and calibration phantom-processed image data were evaluated prospectively from 9 infants (age range, 1 to 163 days) with at least 1 episode of hypoxia and compared with image data from a control population of 16 healthy infants (age range, 1 to 191 days). Custom software was used to make 45 textural feature measurements on 40 x 40-pixel regions of interest within brain parenchyma in the distribution of each major cerebral artery, the thalami, and the cerebellum and in a tissue-mimicking calibration phantom. Means comparison testing was followed by logistic regression to assess statistical variation between the patients and the control group. RESULTS: Nine of 45 textural features showed statistically significant differences between mean values comparing the two groups. Mean gray level was the most sensitive predictor of differences between the two populations (mean gray level for healthy subjects was 46.8; mean gray level for patients was 56.3). An average of mean gray values in areas supplied by the posterior cerebral arteries and the cerebellum was even more sensitive for differentiating healthy subjects from patients. CONCLUSIONS: Quantitative sonographic textural feature analysis showed differences between the brains of healthy infants and those of infants with clinical hypoxia.

US tissue characterization workstation: applications and design.

This article discusses the purpose, design, and uses of an ultrasonographic tissue characterization workstation. The distinguishing characteristic of a tissue characterization workstation is its ability to analyze and classify image textures. Texture is defined as regularly or randomly repeating patterns. Small texture differences in an image are difficult to observe in the presence of noise. Therefore, it is necessary to analyze the image quantitatively. Quantitative measurements include run-length statistics, fractal dimension, and correlation statistics. The workstation is designed so that a radiologist can analyze the patient's images through an easy-to-use graphical user interface. The workstation software is based on standards, so that it can be run on a variety of different hardware platforms. The workstation can be used in a research environment to distinguish between images of malignant and benign breast lesions, which are difficult to diagnose visually. Further work is being done to make the workstation software into a useful clinical tool.

Understanding the process of quantitative ultrasonic tissue characterization.

Because the human vision system cannot distinguish the broad range of gray values that a computer visual system can, computerized image analysis may be used to obtain quantitative information from ultrasonographic (US) real-time B-mode scans. Most quantitative US involves programming an off-line computer to accept, analyze, and display US image data in a way that enhances the detection of changes in small-scale structures and blood flow that occur with disease. Common image textural features used in quantitative US tissue characterization consist of first-order gray-level statistics (eg, occurrence frequency of gray levels independent of location or spatial relationship) and second-order gray-level statistics dependent on location and spatial relationship, including statistical analysis of gradient distribution, co-occurrence matrix, covariance matrix, run-length histogram, and fractal features. A customized tissue signature software has been developed to analyze image data obtained from clinical US scanners. Means comparison testing and multivariate analysis techniques are used to compare the numbers generated for a particular region of interest. By integrating these techniques into the radiologist's interpretation of the sonogram, the quantitative information gained may lead to earlier detection of lesions difficult to see with the human eye.

Improving the distinction between benign and malignant breast lesions: the value of sonographic texture analysis.

To improve the ability of ultrasound to distinguish benign from malignant breast lesions, we used quantitative analysis of ultrasound image texture. Eight cancers, 22 cysts, 28 fibroadenomata, and 22 fibrocystic nodules were studied. The true nature of each lesion was determined by aspiration (for some cysts) or by open biopsy. Analysis of image texture was performed on digitized video output from the ultrasound scanner using fractal analysis and statistical texture analysis methods. The most useful features were those derived from co-occurrence matrices of the images. Using two features together (contrast of a co-occurrence matrix taken in an oblique direction, and correlation of a co-occurrence matrix taken in the horizontal direction), it was possible to exclude 78% of fibroadenomata, 73% of cysts, and 91% of fibrocystic nodules while maintaining 100% sensitivity for cancer. These findings suggest that ultrasonic image texture analysis is a simple way to markedly reduce the number of benign lesion biopsies without missing additional cancers.

Vector quantization distortion of medical ultrasound features.

Pruned-tree structured vectored quantization (PTSVQ) was applied to the lower five gray scale remapped bits of normal and fatty ultrasound liver images. The upper bits were compressed reversibly. This combination of techniques is termed PTSVQ with splitting. The effect of the compression on the difference in texture between normal and fatty liver images was studied at different compression rates and distortions. The changes in texture were measured by changes in the principal components of the covariance matrix of image vectors. The vectors were the same size as those used in the compression technique. There were clear differences in the components of normal and fatty liver images. These differences were largely removed by the PTSVQ with splitting technique even at average single pixel distortions several times smaller than the image noise. These results suggest that the effect of compression on second order statistics should be measured when evaluating algorithms in addition to the first order average distortion.

A comparison of case retrieval times: film versus picture archiving and communications systems.

One of the advantages that a picture archiving and communications system (PACS) is supposed to provide over a film-based operation is improved performance in retrieving images. Although it seems self-evident that this should be so, this experiment was intended to verify this and to provide some time comparisons for the two methods. The experiment consisted of randomly selecting ultrasound and computed tomography cases and determining how long it took to retrieve files at a PACS workstation or in person from the file room. To simulate actual retrieval volumes, a total of 40 cases from current to 6 months old, 20 cases from the past year, and 10 cases more than 1 year old was selected. Results indicate that PACS retrieval can indeed be faster than file room retrieval. However, the difference is less for recent cases than for older cases. For cases 6 or fewer months old, the workstation retrieval was approximately 2.5 minutes faster per case than the film file room. This time difference increased markedly when extended to the 1-year and older-than-1-year groups. This report details the results of this study and provides information about the reliability of the two archives.

Contrast information of digital imaging in laser film digitizer and display monitor.

A 10-bit or 12-bit gray scale is provided in commercial laser film digitizers. The true contrast resolution on the digitized image within a laser spot area of 200 microns in diameter is limited by both the quantum mottle and instrumentation noise. In this report, we investigated the mean value, standard deviation, and adjacent pixel correlation coefficient on a calibrated step wedge film with two laser digitizers. The results were disappointing, because we found that the evaluated contrast information is inferior to the manufacturers' specifications. On the output side, the brightnesses of different gray levels from a clinical monitor were measured with a narrow angle luminance probe and evaluated by a brief human perception study. In addition, the implications for teleradiology applications are discussed.

Noise impact on error-free image compression.

Some radiological images with different levels of noise have been studied using various decomposition methods incorporated with Huffman and Lempel-Ziv coding. When more correlations exist between pixels, these techniques can be made more efficient. However, additional noise disrupts the correlation between adjacent pixels and leads to a less compressed result. Hence, prior to a systematic compression in a picture archiving and communication system (PACS), two main issues must be addressed: the true information range which exists in a specific type of radiological image, and the costs and benefits of compression for the PACS. It is shown that with laser film digitized magnetic resonance images, 10-12 b are produced, although the lower 2-4 b show the characteristics of random noise. The addition of the noise bits is shown to adversely affect the amount of compression given by various reversible compression techniques. The sensitivity of different techniques to different levels of noise is examined in order to suggest strategies for dealing with noise.

MR imaging using a rampable system.

A series of cranial images obtained at three magnetic field strengths in a volunteer on a fast ramp magnetic resonance system is presented. This study was undertaken in the space of 5 h.

The relationship between ATP hydrolysis and active force in compressed and swollen skinned muscle fibers of the rabbit.

We investigated whether the inhibition of force generation observed in compressed muscle fibers is accompanied by a coupled reduction in hydrolytic activity. Isometric force and rates of ATP hydrolysis (ATPase) were measured as functions of the relative width of chemically skinned skeletal muscle fiber segments immersed in relaxing (pCa greater than 8) and activating (pCa 4.9) salt solutions. Osmotic radial compression of the fiber segment was produced (with little or no affect on striation spacing) by adding Dextran T500 to the bathing media. ADP as a product of ATP hydrolysis in fibers undergoing 10-15 min contractions was measured using high pressure liquid chromatography. Compression of the (initially swollen) fiber segment with dextran produced a slight (4%) increase in average active force and then, with further compression, a sharp decrease (with maximum around in situ width). With compression, the average ATPase of the fiber decreased monotonically, and with extreme compression (with 0.22 g dextran per ml), ATPase fell to a fifth of its level determined in dextran-free solution while force was abolished. The time course of active force development was described by the sum of two exponential functions, the faster of which characterized the rate of rise. Fiber compression (0.14 g dextran per ml) reduced the rate of rise of force ten-fold compared to that in dextran-free solution. Hindrance of cross movement is proposed to account for the inhibition of active force generation and (coupled) ATPase in compressed fibers.

Tension and ATPase rate in steady-state contractions of rabbit soleus fiber segments.

Steady-state isometric tension and ATPase were studied in hyperpermeable segments of single muscle fibers from rabbit soleus muscle at 22 degrees C. The ATPase activity was due to actomyosin. The ratio of fiber ATPase to tension was used as an index of steady-state cross-bridge kinetics. Increasing the calcium ion concentration from pCa 8 to pCa 5 activated both tension and ATPase. The maximal tension was 1.35 +/- 0.07 kg/cm2. The maximal ATPase was 1.05 +/- 0.13 mumol X g-1. s-1 at pCa 5.2. ATPase activity increased with tension, such that the ratio of ATPase to tension remained constant at all calcium concentrations. In the absence of calcium, increasing the concentration of MgATP from 1 to 7 X 10(-7) M increased tension from zero to a maximum of 0.46 +/- 0.03 kg/cm2. Increasing MgATP concentration further to 1 X 10(-6) M inhibited tension. In the phase of rising tension, ATPase increased proportionally to tension, to 0.11 +/- 0.01 mumol X g-1 X s-1 at maximum tension. However, the ratio of ATPase to tension on the rising phase had a value only one-third of that seen with calcium-activated tension. Thus, low substrate concentrations, but not low calcium ion concentrations, influence cross-bridge kinetics under steady-state isometric conditions, possibly by an increase in the tension-time product during a cross-bridge cycle.

Force and ATPase rate in skinned skeletal muscle fibers.

Measurements of ATPase, force, and their ratio in chemically and mechanically skinned segments of muscle fibers provide a measure of steady-state kinetics of actomyosin interactions under force-generating conditions and thereby provide unique chemomechanical information. Preparations in which nonactomyosin ATPases are inhibited are available. The ratio of steady-state ATPase to steady-state isometric force (tension cost) was not altered significantly at different degrees of activation of contraction by Ca2+ or by shrinking the fiber lattice progressively to reduce force to zero. A fivefold decrease in tension cost was measured at low MgATP concentrations; data indicate either a decreased cross-bridge cycling time or an increased force per cross-bridge.

The effect of slow releasing oral magnesium chloride on the QTc interval of the electrocardiogram during open heart surgery.

Recent work in both animal and human studies emphasizes the value of magnesium in the maintenance of the functional and structural integrity of cardiac muscle. Both intracellular and extracellular magnesium concentrations can vary independently and the serum and red cell magnesium levels may not give an accurate account of intracellular cardiac magnesium deficiency. However, electrocardiographic studies of magnesium levels could provide an accurate index of intracellular cardiac magnesium levels. Twenty-four patients scheduled electively for mitral valve replacement were studied to evaluate the effect of slow releasing oral magnesium chloride on the QTc interval of the electrocardiogram. Although pretreatment QTc values in all patients were not significantly different, there was a highly significant difference between the control group and the treatment group after four days of preoperative treatment with oral magnesium chloride. During the postoperative phase of the trial, all patients developed a similar pattern of increase in QTc interval, reaching a peak at the end of the second day and followed by a decrease over the final two days. All patients who developed arrhythmias postoperatively had not been pretreated (primed) with oral magnesium chloride and had abnormal QTc intervals both before and after operation. The results of this study demonstrate the usefulness of oral magnesium chloride in reducing the QTc interval of the electrocardiogram and so protecting the myocardium against possible arrhythmias.

Nonparallel isometric tension response of rabbit soleus skinned muscle fibers to magnesium adenosine triphosphate and magnesium inosine triphosphate.

The isometric tension response of single "skinned' rabbit soleus muscle fibers to MgATP and McITP in the absence of calcium was studied. [MgATP] or [MgITP] was varied in solutions of ionic strength 0.30 and temperature 20 degrees C. Steady-state tension that developed in MgATP or MgITP solutions was a biphasic bell-shaped function of log [MgATP] or log [MgITP] which increased from zero to maximum tension and then declined again to zero. Analysis of the data showed that, under comparable ionic conditions, percent tension vs. log [MgATP] and percent tension vs. log [MgITP] curves are not parallel. Instead, the percent tension vs. log [MgITP] curve is much broader. Additionally, under comparable ionic conditions maximum tension in MgITP solutions was higher than in MgATP solutions. In addition, in MgATP solutions, pH, [K+], and excess ATP were varied. Raising pH from 7 to 8, [K+] from 46 mM to 200 mM, or decreasing excess ATP from 2 to 0.5 mM all increased maximum tension. None of these factors, however, influenced the shape or position of the percent tension vs. log [MgATP] curve.

Cardiac effects of magnesium with special reference to anaesthesia: a review.

The role of magnesium in myocardial metabolism and the effects of magnesium deficiency on myocardial contraction and the electrocardiogram have been described. The causes of a magnesium deficiency have been discussed in some detail. Finally, the inter-relationship between magnesium and the mitochondrial enzyme systems concerned with oxidative phosphorylation is stressed. The early detection of magnesium deficiency by routine methods is imperative for the prevention of abnormal cardiac metabolism and the maintenance of the functional and structural integrity of cardiac muscle during anaesthesia.

A study of abortion and problems in decision-making.

PIP: This paper is directed to those individuals who are sufficiently disturbed by the complex realities of problem pregnancies and who are prepared to think beyond the confines of ideology. Rigid ideological positions tend to create distance from the hard complexities surrounding concrete human situations and to limit the realities of pain and helplessness that may exist for each of the parties to an unwanted pregnancy. Pregnancy is more than a biological condition or an isolated emotional entity giving rise to joy or grief. Pregnancy introduces a new relational component to an already existing relational network, and, conversely, abortion is neither simply the evacuation of the products of conception nor an endpoint to emotional stress. It is, in actuality, a broken relationship. In the clinical experience of these authors a sense of sadness frequently accompanies a woman's choice to undergo an abortion. Some problem pregnancy counselors maintain that they have never known a woman who terminated pregnancy without sadness. This information reinforces these authors' observations that facing a decision to have an abortion is not easy, often stressful, and an occasion when a woman should feel entitled to obtain the help of her total relationship system in arriving at a decision. The decision to continue or to terminate a problem pregnancy is rooted in a complex network of relationship factors that have an effect on the decision-making process. Repeated occurrences of unwanted pregnancies in the family are more than individual and disconnected events. Relational strategies that effect decision-making in problem pregnancies are effective in the hands of helping agents who value conjoint, intergenerational reciprocity as a therapeutic paradigm.^ieng