The authors have developed a semiautomatic segmentation algorithm for measuring the VWV of the carotid artery using 3D US images with reduced operator interaction and computational time and higher reproducibility using a commercially available 3D US transducer. Their method is a step forward toward routine longitudinal monitoring of 3D plaque progression.
Objective: As investigations into nonsurgical treatment for atherosclerosis expand, the measurement of plaque regression and progression has become an important end point to evaluate. Measurements of three-dimensional (3D) plaque volume are more reliable and sensitive to change than are traditional estimates of stenosis severity or cross-sectional area. 3D ultrasound (3D US) imaging may allow monitoring of plaque volume changes but has not been used routinely due to the cumbersome motorized units required to drive transducers. We investigated the variability, reliability, and the least amount of change detectable by 1D plaque measures, as well as 2D and 3D measures of plaque morphometry, that can be applied in a clinical environment. Methods: 3D US imaging was obtained in 10 patients with carotid stenosis. The lumen and outer wall boundaries were outlined in serial cross-sectional images 1 mm apart. Three observers manually segmented vessel wall volumes (VWVs), and the segmentation was repeated again 4 weeks later. This allowed measurement of interobserver and intraobserver variability of 6 pairs of observations. We measured Bland-Altman statistics, intraclass correlation coefficients, coefficient of variability, and the minimum detectable plaque change for each morphometric measure. Results: The mean VWV of carotid lesions in the study was 1276.8 mm 3 (range, 620.6-1956.3 mm 3). Bland-Altman plots demonstrated low interobserver and intraobserver variability. The interobserver variability of volume measurements as a function of mean volume was 14.8% and interobserver variability was 8.9%. Reliability was 87% as quantified by the interclass correlation and was 95% by the intraclass correlation. The least detectable change in VWV was 12.9% for interobserver variability and 4.5% for intraobserver variability for the three observers. Conclusions: Carotid plaque diameter measurements from B-mode images have high variability. Plaque burden, as estimated by VWV, can be measured reliably with a 3D US technique using a clinical scanner. The volumetric change, with 95% confidence, that must be observed to establish that a plaque has undergone growth or regression is w12.9% for different observers and 4.5% for the same observer performing the follow-up study.
Objectives To compare a mechanical heterogeneity index derived from ultrasound vibration elastography with physical findings before and after dry-needling treatment of spontaneously painful active myofascial trigger points in the upper trapezius muscle. Methods Forty-eight patients with chronic myofascial pain enrolled in a prospective interventional trial of 3 weekly dry-needling treatments for active myofascial trigger points. Trigger points were evaluated at baseline and at treatment completion using palpation, the pressure-pain threshold, and the mechanical heterogeneity index. Thirty patients were reevaluated at 8 weeks. Trigger points that “responded” changed to tissue that was no longer spontaneously painful, with or without the presence of a palpable nodule. Trigger points that “resolved” changed to tissue without a palpable nodule. The mechanical heterogeneity index was defined as the proportion of the upper trapezius muscle that appeared mechanically stiffer on elastography. Statistical significance for comparisons was determined at P < .05. Results Following 3 dry needle treatments, the mechanical heterogeneity index decreased significantly for the 38 myofascial trigger points (79% of 48) that responded to treatment. Among these, the baseline mechanical heterogeneity index was significantly lower for the 13 trigger points (27% of 38) that resolved, but the decrease after 3 dry needle treatments did not reach significance. The pressure-pain threshold improved significantly for both groups. At 8 weeks, the mechanical heterogeneity index decreased significantly for the 22 trigger points (73% of 30) that responded and for the 10 (45% of 22) that resolved. The pressure-pain threshold improvement was significant for trigger points that responded but did not reach significance for resolved trigger points. Conclusions The mechanical heterogeneity index identifies changes in muscle tissue properties that correlate with changes in the myofascial trigger point status after dry needling.
In transversely isotropic (TI) materials, mechanical properties (Young's modulus, shear modulus, and Poisson's ratio) are different along versus across the axis of symmetry (AoS). In this work, the feasibility of interrogating such directional mechanical property differences using acoustic radiation force impulse (ARFI) imaging is investigated. We herein test the hypotheses that 1) ARFI-induced peak displacements (PDs) vary with TI material orientations when an asymmetrical ARFI excitation point spread function (PSF) is used, but not when a symmetrical ARFI PSF is employed; and 2) the ratio of PDs induced with the long axis of an asymmetrical ARFI PSF oriented along versus across the material's AoS is related to the degree of anisotropy of the material. These hypotheses were tested in silico using finite element method (FEM) models and Field II. ARFI excitations had F/1.5, 3, 4, or 5 focal configurations, with the F/1.5 and F/5 cases having the most asymmetrical and symmetrical PSFs at the focal depth, respectively. These excitations were implemented for ARFI imaging in 52 different simulated TI materials with varying degrees of anisotropy, and the ratio of ARFI-induced PDs was calculated. The change in the ratio of PDs with respect to the anisotropy of the materials was highest for the F/1.5, indicating that PD was most strongly impacted by the material orientation when the ARFI excitation was the most asymmetrical. On the contrary, the ratio of PDs did not depend on the anisotropy of the material for the F/5 ARFI excitation, suggesting that PD did not depend on material orientation when the ARFI excitation was symmetrical. Finally, the ratio of PDs achieved using asymmetrical ARFI PSF reflected the degree of anisotropy in TI materials. These results support that symmetrical ARFI focal configurations are desirable when the orientation of the ARFI excitation to the AoS is not specifically known and measurement standardization is important, such as for longitudinal or cross-sectional studies of anisotropic organs. However, asymmetrical focal configurations are useful for exploiting anisotropy, which may be diagnostically relevant. Feasibility for future experimental implementation is demonstrated by simulating ultrasonic displacement tracking and by varying the ARF duration.
Direct ultrasonic imaging of arterial and venous thrombi could aid in diagnosis and treatment planning by providing rapid and cost-effective measurements of thrombus volume and elastic modulus. Toward this end, it was demonstrated that open-air magnetomotive ultrasound (MMUS) provides specific contrast to superparamagnetic iron oxide-labeled model thrombi embedded in gelatin-based blood vessel-mimicking flow phantoms. MMUS was performed on model thrombi in the presence of pulsatile flow that mimics cardiac-induced motion found in real vasculature. The MMUS signal and contrast-to-noise ratio (CNR) were measured across a range of physiologically relevant thrombus volumes and elastic moduli. Model thrombus volumes as small as 0.5 ml were shown to be detectable (CNR > 1) over the entire range of elastic moduli tested (3.5-40 kPa). It was also found that MMUS signal and CNR are increased with increasing thrombus volume ( ) and decreasing elastic modulus ( ), while variations in pulsatile flow rate had little effect. These findings demonstrate that MMUS has promise as a direct in vivo thrombosis imaging modality for quantifying thrombus volume and stiffness.
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