Advancements in the Application of Ultrasound Elastography in the Cervix.

Ultrasound elastography is a modern imaging technique that has developed rapidly in recent years. It enables objective measurement of tissue stiffness, a physical property intuitive to the human sense of touch. This novel technology has become a hotspot and plays a major role in scientific research and academic practice. Presently, ultrasound elastography has been used in the identification of benign and malignant tumors in superficial organs, such as breast and thyroid, providing clinically accurate diagnosis and treatment. The method has also been widely used for the liver, kidney, prostate, lymph nodes, blood vessels, skin and muscle system. In the application of cervical lesions, ultrasound elastography can distinguish normal cervix from abnormal cervix and differentiate benign from malignant lesions. It can significantly improve the diagnostic specificity for cervical cancer and is also useful for assessing infiltration depth and stage of cervical cancer, as well as predicting chemoradiotherapy treatment response. For cervical evaluation during pregnancy, ultrasound elastography is useful for assessing cervical softening and predicting premature delivery and outcome of induced labor. This article reviews the principles of ultrasound elastography as well as the current status and limitations in its application for cervical lesions and the cervix during pregnancy.

Grading Bleomycin-Induced Pulmonary Fibrosis in ex vivo Mouse Lungs Using Ultrasound Image Analysis.

OBJECTIVES: The aim of this study was to assess bleomycin-induced pulmonary fibrosis on ex vivo mouse lungs using ultrasound image grading and texture analysis. METHODS: Excised mouse lungs were divided into 3 groups: control, mild fibrosis, and severe fibrosis based on the monitored indicators of health. B-mode ultrasound images were obtained via scanning the mouse lungs ex vivo. The surface smoothness, echo density, and angle of lesions or the lung margin were graded, and the imaging contrast, correlation, homogeneity, and entropy were assessed via texture analysis. RESULTS: The grades of surface smoothness, echo density, and angle were statistically higher for the severe fibrosis group compared with those of the control and mild fibrosis groups (P < .05). In addition, statistically significant differences in the contrast, correlation, and homogeneity between mild and severe fibrosis groups were observed (P < .05). CONCLUSIONS: The results obtained in this study suggest that ultrasound image grading and texture analysis are valuable and meaningful methods for assessing pulmonary fibrosis in a bleomycin mouse model.

Deep Convolutional Neural Networks for Thyroid Tumor Grading using Ultrasound B-mode Images.

The performances of deep convolutional neural network (DCNN) modeling and transfer learning (TF) for thyroid tumor grading using ultrasound imaging were evaluated. This retrospective study included input patient data (ultrasound B-mode image sets) assigned to the training group (115 participants) or testing group (28 participants). DCNN (ResNet50) and TF (ResNet50, ResNet101, ResNet152, VGG16, Inception V3, and DenseNet201), which trains a convolutional neural network that has been pre-trained on ImageNet, were used for image classification based on thyroid tumor grade. Supervised training was performed by using the DCNN or TF model to minimize the difference between the output data and clinical grading. The performances of the DCNN and TF models were assessed in the testing dataset with receiver operating characteristic analyses. Results showed that TF based on Resnet50 and VGG16 had better performance than DCNN (ResNet50) in differentiating thyroid tumor with areas under the receiver operating characteristic (AUCs) curve more than 0.8. However, TF based on ResNet101, ResNet152, InceptionV3, and Densenet201 had equal or worse performances than DCNN (ResNet50) in grading thyroid tumor with AUCs less than 0.5. TF based on ResNet50 and VGG16 had a superior performance compared to DCNN (ResNet50) model for grading thyroid tumors based on ultrasound images.

Ultrasound vibro-elastography for assessing mechanical properties of porcine reproductive tissues in an ex vivo model.

BACKGROUND: The aim of this study was to use ultrasound vibro-elastography (UVE) for measuring surface wave speed and assessing mechanical properties of ex vivo porcine reproductive tissues, including the uterus, bladder, cornua and cervix. METHODS: In UVE, a 0.1-s harmonic vibration at low frequency was generated on the tissue surface with a handheld shaker. A linear-array ultrasound probe was used to measure the resulting surface wave propagation. Surface wave speeds of tissues were measured in the frequency range of 100-300 Hz. Mechanical properties of the tissue were calculated based on wave speed dispersion with frequency. FINDINGS: The obtained results showed that the surface wave speeds of porcine bladder, cervix, cornua and uterus increased with frequency. There were no statistically significant differences in the wave speeds or mechanical properties among the porcine bladder, cervix, cornua and uterus. INTERPRETATION: Experimental data obtained in this study may be used as a reference to study in vivo surface wave speed or mechanical properties for porcine or human reproductive tissues.

Ultrasound Vibroelastography for Evaluation of Secondary Extremity Lymphedema: A Clinical Pilot Study.

BACKGROUND: Lymphedema treatment is an ongoing challenge. It impacts quality of life due to pain, loss of range of motion of the extremity, and repeated episodes of cellulitis. Different modalities have been used to evaluate lymphedema; some are more error-prone and some are more invasive. However, these measurements are poorly standardized, and intrarater and interrater reliabilities are difficult to achieve. This pilot study aims to assess the feasibility of ultrasound vibroelastography for assessing patients with extremity lymphedema via measuring shear wave speeds of subcutaneous tissues. METHODS: Patients with clinical and lymphoscintigraphic diagnosis of secondary lymphedema in the extremities without prior surgical treatment were included. A 0.1-s harmonic vibration was generated at three frequencies (100, 150, and 200 Hz) by the indenter of a handheld shaker on the skin. An ultrasound probe was used for noninvasively capturing of wave propagation in the subcutaneous tissue. Wave speeds were measured in the subcutaneous tissues of both the control and affected extremities. RESULTS: A total of 11 female patients with secondary lymphedema in the extremities were enrolled in this study. The magnitudes of the wave speeds of the region of interest in the subcutaneous tissue at lymphedema sites in the upper extremity (3.9 ± 0.17 m/s, 5.96 ± 0.67 m/s, and 7.41 ± 1.09 m/s) were statistically higher than those of the control sites (2.1 ± 0.27 m/s, 2.93 ± 0.57 m/s, and 3.56 ± 0.76 m/s) at 100, 150, and 200 Hz (P < 0.05), and at 100 and 200 Hz (P < 0.05) between lymphedema (4.33 ± 0.35 m/s, 4.17 ± 1.00 m/s, and 4.56 ± 0.37 m/s) and controls sites (2.48 ± 0.43 m/s, 2.77 ± 0.55 m/s, and 3.06 ± 0.29 m/s) in the lower extremity. CONCLUSIONS: These preliminary data suggest that ultrasound vibroelastography may be useful in the evaluation of secondary lymphedema and can be a valuable tool to noninvasively track treatment progress.

Acupuncture Combined with Hydrotherapy in Diabetes Patients with Mild Lower-Extremity Arterial Disease: A Prospective, Randomized, Nonblinded Clinical Study.

BACKGROUND The aim of this pragmatic study was to explore the intervention of acupuncture combined with hydrotherapy and perceived effects in type 2 diabetic patients with recently diagnosed, mild, lower-extremity arterial disease (LEAD) in comparison with a control group. MATERIAL AND METHODS One hundred twenty-six diabetes patients who were diagnosed mild LEAD according to ankle-brachial blood pressure index (ABPI) and peripheral neuropathy symptom were randomly assigned to either an experimental (n=64) or control group (n=62). The experimental group attended and completed (1) a 30-min session of acupuncture in certain selected points, and (2) a 30-min hydrotherapy exercise every 2 days for 15 weeks. The outcome parameters were assessed at baseline, after intervention, and at 6-week follow-up. RESULTS The intervention was associated with an improvement in leg flow conductance and partial physical capacities, including chair-sit-and-reach, the walking impairment questionnaire (WIQ), and physical component summary score (PCS), compared to the control group. The treatment benefits were sustained throughout the 6-week follow-up endpoint. There was no difference in fasting glucose levels, Hb1Ac, blood pressure, or BMI after the intervention. At the endpoint of 6-week follow-up, acupuncture plus hydrotherapy appeared to reduce inflammatory response by decreasing IL-6, TNF-α, malondialdehyde, and SOD, and increasing glutathione. CONCLUSIONS Acupuncture plus hydrotherapy, without significant glycemic-controlling effects in the type 2 diabetic patients with mild LEAD, exerts a measurable benefit in disease-specific physical functions and health-related quality of life. Our results suggest that the combined therapy regulates the inflammatory process and oxidative stress and contributes to immune protection.

The relationship between body adiposity index and pregnancy-induced hypertension in third-trimester pregnant women.

The aim of this study was to evaluate the relationship between body adiposity index (BAI) and pregnancy-induced hypertension (PIH) in third-trimester pregnant women. This study included 126 women in the third trimester of pregnancy. All participants completed anthropometric measurements and ultrasonic testing. The formula of BAI was hip circumference (cm)/height (m)-18. The frequency of PIH were significantly higher in the upper tertile group (31.0%) than in the low tertile group (7.1%) and the middle tertile group (4.8%) (P<0.01). The area under curve values for the accuracy of BAI in identifying PIH were 0.784. The optimal threshold of BAI for identifying PIH was 36.0. The sensitivity was 72.2% and the specificity was 85.1%. BAI was correlated with PIH. The performance of BAI for identifying third-trimester pregnant women with PIH was moderately accurate.

The relationship between neck circumference and pregnancy-induced hypertension in the third trimester pregnant women.

OBJECTIVE: The purpose of this study was to evaluate the relationship between neck circumference (NC) and pregnancy-induced hypertension (PIH) in the third trimester pregnant women. METHODS: The study included 126 women who were in the third trimester pregnancy. All subjects completed a standard sleep questionnaire, anthropometric measurements and ultrasonic testing. RESULTS: Pregnant women with NC ≥34.7 cm had significantly higher frequency of PIH than pregnant women with NC <34.7 cm (35.6% versus 2.5%, χ(2 )= 25.863, p = 0.000). CONCLUSIONS: The increase of NC was independent risk factor for PIH in the third trimester pregnant women.