Rapid 3-D imaging of contrast flow: application in a perfused kidney phantom.

Previous studies indicate imaging of ultrasound contrast in 3-D is potentially superior to 2-D imaging for vascular characterization. A dual-beam, dynamic refill technique, which relies on volumetric contrast clearance and sequential imaging, was used to image a preserved porcine kidney perfused with contrast. A model was developed for the contrast profile across the renal artery to estimate fractional blood volume. This model was used along with refill curve information to measure absolute perfusion within renal cortex for a 100-cm(3) volume. Perfusion measurements from a slice within the volume were also made using a modified interval imaging technique. The measured perfusion using the dual-beam technique was consistent with the perfusion measured using the interval imaging technique (dual-beam values were 1.06 +/- 0.04 x corresponding interval imaging values). These experiments suggest that ultrasound contrast perfusion measurements are independent of the volume of contrast eliminated before refill.

Discrimination of sonographically detected breast masses using frequency shift color Doppler imaging in combination with age and gray scale criteria.

Frequency shift color Doppler imaging was assessed in conjunction with patient age and gray scale (GS) features for discriminating benign from malignant breast masses. Thirty-eight women with sonographically detected masses scheduled for biopsy were evaluated using a 6- to 13-MHz scan head, and the masses were delineated in ultrasonographic image volumes. Vascularity in and around each mass was quantified using speed-weighted pixel density (SWD). Gray scale features were ranked visually on a linear scale. Combinations of indices were compared with histologic findings (18 benign and 20 malignant). Receiver operating characteristic analysis ranked performance in decreasing order from the SWD-Age-GS index, to SWD-GS, SWD-Age, Age-GS, GS criteria, SWD, and Age. At 100% sensitivity, SWD-Age-GS, SWD-GS, and SWD-Age discriminated benign from malignant masses with specificities of 94%, 89%, and 72%, respectively. These results indicate significant improvement in ultrasonographic discrimination of sonographically detected breast masses by combining the vascularity measure SWD with age and GS criteria.

3D spatial compounding of ultrasound images using image-based nonrigid registration.

Medical ultrasound images are often distorted enough to significantly limit resolution during compounding (i.e., summation of images from multiple views). A new, volumetric image registration technique has been used successfully to enable high spatial resolution in three-dimensional (3D) spatial compounding of ultrasound images. Volumetric ultrasound data were acquired by scanning a linear matrix array probe in the elevational direction in a focal lesion phantom and in a breast in vivo. To obtain partly uncorrelated views, the volume of interest was scanned at five different transducer tilt angles separated by 4 degrees to 6 degrees. Pairs of separate views were registered by an automatic procedure based on a mutual information metric, using global full affine and thin-plate spline warping transformations. Registration accuracy was analyzed automatically in the phantom data, and manually in vivo, yielding average registration errors of 0.31 mm and 0.65 mm, respectively. In the vicinity of the warping control points, registrations obtained with warping transformations were significantly more accurate than full affine registrations. Compounded images displayed the expected reduction in speckle noise and increase in contrast-to-noise ratio (CNR), as well as better delineation of connective tissues and reduced shadowing. Compounding also revealed some apparent low contrast lobulations that were not visible in the single-sweep images. Given expected algorithmic and hardware enhancements, nonrigid, image-based registration shows great promise for reducing tissue motion and refraction artifacts in 3D spatial compounding.

Semiautomatic registration of volumetric ultrasound scans.

We demonstrate the ability to register easily and accurately volumetric ultrasound scans without significant data preprocessing or user intervention. Two volumetric ultrasound breast scan data sets were acquired from two different patients with breast cancer. Volumetric scan data were acquired by manually sweeping a linear array transducer mounted on a linear slider with a position encoder. The volumetric data set pairs consisted of color flow and/or power mode Doppler data sets acquired serially on the same patients. A previously described semiautomatic registration method based on maximizing mutual information was used to determine the transform between data sets. The results suggest that, even for the deformable breast, three-dimensional full affine transforms can be sufficient to obtain clinically useful registrations; warping may be necessary for increased registration accuracy. In conclusion, mutual information-based automatic registration as implemented on modern workstations is capable of yielding clinically useful registrations in times <35 min.

Differentiation of sinus tachycardia from ventricular tachycardia with 1:1 ventriculoatrial conduction in dual chamber implantable cardioverter defibrillators: feasibility of a criterion based on the atrioventricular interval.

Tachycardia discrimination in future implantable cardioverter defibrillators (ICDs) is likely to be enhanced by the addition of an atrial sensing/pacing lead. However, differentiation of sinus tachycardia (ST) from ventricular tachycardia (VT) with 1:1 VA conduction will remain problematic. We assessed the use of the AV interval as a potential criterion for correctly differentiating ST from VT. Incremental V pacing at the right ventricular (RV) apex served as a "VT" model in each of 41 patients with 1:1 VA conduction to pacing cycle lengths < or = 450 msec. High right atrial and RV apical electrograms during normal sinus rhythm (NSR) and during incremental V pacing were digitized (simulating ICD sensing). From these signals, AV interval versus pacing cycle length plots were computer generated to identify crossover cycle lengths, each defined as the cycle length at which the AV interval during V pacing equals the AV interval during NSR. At cycle lengths longer than the crossover value, the AV interval during "VT" exceeds the AV interval during NSR. In contrast, the AV interval during ST is physiologically shorter than the AV interval during NSR. Thus, ST can be readily differentiated from "VT" over a range of cycle lengths greater than the crossover value. The overall mean calculated crossover cycle length was 371 +/- 52 msec. In 11 patients paced multiple times, each crossover cycle length was reproducible (mean coefficient of variation was 1.2% +/- 0.9% per patient). AV intervals measured at the RV apex were also analyzed with incremental V pacing during catecholamine stimulation (isoproterenol, n = 5) and during alternate site "VT" (RV outflow tract [n = 8] and left ventricle [n = 2]). In all these cases, the new "VT" plots of AV interval versus pacing cycle length coincided with or fell to the left of those obtained during control RV apical pacing and recording (i.e., these AV interval values crossed the NSR baseline at cycle lengths < or = the crossover cycle length). Thus, the cycle length range for recognizable differentiation of ST from "VT" remained valid. The data suggest that the described AV interval criterion relying on the crossover cycle length: (1) is a promising approach to improve differentiation of ST from relatively slow VTs with 1:1 VA conduction, and (2) can readily be automated in future dual chamber ICDs, given its computational simplicity.

Continuous wave laser ablation of tissue: analysis of thermal and mechanical events.

Thermal and mechanical events during continuous wave (CW) laser ablation of biological and phantom media were investigated. Porcine aortae, collagen fibers, and polyacrylamide control samples were subjected to argon laser irradiation while infrared and high-speed (240 images/s) video cameras were used to monitor their surfaces. Subsequent analysis of simultaneous changes in surface temperature and physical features correlated thermal and mechanical events. Video images recorded prior to ablation onset of tissue slabs clearly revealed two distinct phases: 1) progressive growth of a surface dehydration zone, and 2) surface deformation, implying subsurface bubble formation. Surface temperature recordings and video imaging revealed that the onset of CW ablation of soft biological media often initiated with a violent explosion, surface tearing, and tissue ejection. Histological inspection revealed intense coagulation in superficial layers near the irradiation site, whereas chiefly mechanical disruption was noted at the base of the crater. Ablation characteristics were consistent with theoretical calculations which indicate subsurface temperature peaks that increase in magnitude and surface proximity as energy deposition rates are increased. Results also suggested that mechanical properties of target media strongly influenced the extent of pressure built up, the nature of ablation onset, and the characteristics of the overall ablation pathway.

Laser thermal ablation.

Continuous wave and pulsed laser ablation of tissue is described as an explosive event. A subsurface temperature maximum and superheated tissue produce high pressures that eject fragments from the tissue. Decreased water content due to dehydration and vaporization decreases thermal conductivity which reduces heat conduction. Also, a decrease in water content dramatically alters the local rate of heat generation of laser radiation above 1.3 microns since water is the primary absorber. In contrast, at UV wavelengths protein and DNA are the primary absorbers so destruction of tissue bonds is due to direct absorption of the laser light rather than heat transfer from water.