Opportunistic Ultrasound Screening for Abdominal Aortic Aneurysm.

Objective: In patients with abdominal aortic aneurysm (AAA), early detection and optimal elective treatment before rupture are desirable. In the absence of an established public screening system, opportunistic screening during ultrasound examination for another purpose might be efficacious. The aim of this study was to evaluate the efficacy of opportunistic screening for AAA. Methods: This prospective multicenter observational study enrolled patients who were scheduled to undergo ultrasound for reasons other than AAA. After the ultrasound for the original purpose, evaluation of the abdominal aorta was added. If the abdominal aorta was clear enough for measurement, its diameter and shape were recorded. Furthermore, information on comorbidities was collected for each patient. Results: A total of 10325 patients (echocardiography: 6150; abdominal ultrasound: 4162) from 16 institutions were enrolled. The abdominal aorta was well visualized in 92.9% of patients who underwent echocardiography. Among 9791 patients, AAA was diagnosed in 122 (1.3%) (107 fusiform and 15 saccular), with a diameter range of 30-63 mm. The diagnostic rate increased with age. On multivariate analysis, older age, male sex, coronary artery disease, peripheral arterial disease, and smoking habituation were the risk factors for AAA. Conclusion: Opportunistic screening for AAA was efficacious.

Evaluation of temperature-dependent fluctuations in skin microcirculation flow using a light-emitting diode based photoacoustic imaging device.

PURPOSE: Skin microvessels maintain temperature homeostasis by contracting and dilating upon exposure to changes in temperature. Under general anesthesia, surgical invasiveness, including incisions and coagulation, and the effects of anesthetics may cause variations in the threshold temperature, leading to the constriction and dilation of cutaneous blood vessels. Therefore, studies on skin microvascular circulation are necessary to develop appropriate interventions for complications during surgery. METHODS: We visualized and quantified skin microcirculatory fluctuations associated with temperature variations using a light-emitting diode photoacoustic imaging (LED-PAI) device. The hands of ten healthy volunteers were stressed with four different water temperatures [25℃ (Control), 15℃ (Cold1), 40℃ (Warm), and 15℃ (Cold2)]. The photoacoustic images of the fingers were taken under each condition, and the microvascular flow owing to temperature stress was quantified as the area of photoacoustic signal (S) in each image. The S values were compared with the variations in blood flow (Q) measured by laser Doppler flowmetry (LDF). RESULTS: The correlation between Q and S according to the 40 measurements was r = 0.45 (p＜0.01). In addition, the values of S under each stress condition were as follows: Scontrol = 10,826 ± 3364 pixels, Scold1 = 8825 ± 2484 pixels, Swarm = 13,369 ± 3001 pixels, and Scold2 = 8838 ± 1892 pixels; the differences were significant. The LDF blood flow (Q) showed similar changes among conditions. CONCLUSION: These findings suggest that the LED-PAI device could be an option for evaluating microcirculation in association with changes in temperature.

The effects of hydroxyethyl starch 130/0.4 on perioperative renal function in patients undergoing cardiac surgery: A randomised controlled trial.

Background: Acute kidney injury (AKI) after cardiac surgery increases the risk of morbidity and mortality. Hydroxyethyl starch (HES) is often used during surgery due to its plasma-volume expanding effect, but the impact of HES 130/0.4 on renal function in patients undergoing cardiac surgery remains unclear. The aim of our study is to investigate the impact of HES 130/0.4 on postoperative renal function in patients undergoing cardiac surgery using cardiopulmonary bypass. Methods: Our study was a randomised, single-center, single-blind study conducted on 60 adult patients who underwent cardiac surgery using cardiopulmonary bypass: 30 patients were intraoperatively administered with HES 130/0.4; the other 30 with Ringer's bicarbonate. The primary endpoints were occurrence of AKI within 30 days of surgery and the disease stages. Results: The mean dose of 6% HES 130/0.4 was 28 ml/kg. AKI occurred within 30 days of the operation in 8 cases (28.6%) in the HES group and 6 cases (21.4%) in the crystalloid group (no significance: p = 0.5371). Disease stages were as follows: "no AKI", "stage 1", "stage 2″ and "stage 3″, accounting for 20 cases (71.5%), 6 cases (21,4%), 2 cases (7.1%), and 0 cases, respectively, in the HES group, and 22 cases (78.6%), 6 cases (21.4%), 0 cases, and 0 cases, respectively, in the crystalloid group (no significance: p = 0.3508). Conclusion: There was no significant difference in the occurrences or stages of AKI during the 30 days following cardiac surgery with cardiopulmonary bypass between patients administered with HES 130/0.4 or Ringer's bicarbonate.

A histoanatomical study of the fiber bundle forming the 'Comma Sign,' a critical marker of the torn edge of the subscapularis tendon.

INTRODUCTION: The "Comma sign" is a well-known indicator of the subscapularis torn edge of the shoulder. We undertook a histoanatomical study of the fiber bundle forming Comma sign (FBCS) to determine why FBCS is maintained even in cuff tear cases. MATERIALS AND METHODS: Part 1: five tissue blocks including the supraspinatus tendon (SSP), rotator interval (RI), and subscapularis tendon (SSC) out of 5 cuff-intact cadavers were histologically observed in serial sections. Part 2: another tissue blocks of 6 cuff-intact cadavers were serially sectioned along the estimated FBCS direction based on the Part 1 findings. Additionally, 5 tissue blocks of cuff-torn cadavers including the three components, SSP, FBCS, and SSC, were serially sectioned along the apparent FBCS. In one slice clearly demonstrating FBCS fibers out of each section series, the components were measured of the sound speed and visualized through a scanning acoustic microscope (SAM). RESULTS: At the lateral portion, RI tissue with the joint capsule became thick and tightly surrounded SSP. Similarly, thicker RI tissue adhered to SSC from the superior and bursal side. More laterally, the borders of SSP/FBCS and FBCS/SSC were unclear with intermingled fibers. At the lateral most portion, RI tissue formed a fiber bundle, FBCS, extending from SSP to the bursal side of SSC. The sound speeds of SSP and SSC were significantly faster than FBCS in both cuff-intact and cuff-torn slices. In SAM images of cuff-torn specimens the FBCS borders were all unclear. CONCLUSIONS: As FBCS extends from the capsule beneath SSP and to the bursal surface of SSC, the FBCS connection to SSP and SSC is hardly lost, even though SSP or SSC detaches from the greater or lesser tubercle, respectively. Additionally, as degeneration make the elasticity difference gradual, the stress concentration at the borders may be diminished, leading to less breakage of FBCS.

Left Ventricular Blood Flow Dynamics In Aortic Stenosis Before And After Aortic Valve Replacement.

Surgical intervention for aortic valve stenosis (AS) has been established; however its diagnosis based on echocardiographic assessment is still limited by aortic valvular velocity, aortic valvular pressure gradients, and color Doppler imaging. Echo-dynamography (EDG) is a method to determine intracardiac flow dynamics, such as two-dimensional blood flow velocity, vortex, and dynamic pressure. These flow dynamics may be influenced by left ventricular (LV) wall motion and the resistance in LV outflow caused by AS. The objective of the present study was to assess the changes and differences in LV vortices and vorticity before and after AS surgery. Five patients who underwent aortic valve replacement surgery for AS and five control patients were included. Besides routine echocardiographic measurement, EDG was applied to determine the two-dimensional blood flow vector and vorticity. The LV vortex flow in the isovolumetric contraction phase had multiple formations in preoperative cases. The clockwise vortex was found in all cases postoperatively; the vortex formation showed no significant difference between postoperative and normal control groups. EDG may serve important information on LV flow dynamics, non-invasively.

Visualization of murine lymph vessels using photoacoustic imaging with contrast agents.

Metastasis frequently occurs even in the early stage of breast cancer. This research studied the feasibility of using photoacoustic (PA) imaging for identifying metastasis in the lymph vessels of mice. The photoacoustic efficiency of various contrast agents was investigated, and the influence of scattered light was evaluated by using a lymph vessel phantom. The lymph vessels of mice were then visualized using the selected contrast agents: indocyanine green (ICG) and gold nanorods (AuNR). The attenuation of the PA imaging was -1.90 dB/mm, whereas that of the fluorescence imaging was -4.45 dB/mm. The results indicate the potential of identifying sentinel lymph nodes by using PA imaging with these contrast agents.

A novel biodegradable external mesh stent improved long-term patency of vein grafts by inhibiting intimal-medial hyperplasia in an experimental canine model.

OBJECTIVES: Increased hemodynamic stress on vein grafts used in the arterial system is associated with vein graft disease. We determined whether a novel biodegradable external mesh stent could inhibit medial-intimal hyperplasia by suppressing hemodynamic stress on vein grafts and improve long-term patency. METHODS: Twenty-four beagles underwent bilateral femoral interposition grafting using reversed femoral veins. Vein grafts were externally supported by a novel poly L-lactide-ε-caprolactone copolymer (P(LA/CL)) biodegradable mesh stent or a nonabsorbable mesh stent. Vein grafts with no reinforcement were used as controls. The grafts were harvested 6 and 12 months after implantation for morphometric and immunohistochemical assessment. RESULTS: The endoluminal circumferential vein graft length was smaller in the P(LA/CL) and nonabsorbable groups (17.2 ± 2.9 and 19.0 ± 0.3 mm, respectively), than that in the control group (25.0 ± 2.6 mm, P < 0.01) at 12 months. The mean intimal-medial thickness was thinner in P(LA/CL) and nonabsorbable stent groups (0.18 ± 0.05 and 0.16 ± 0.05 mm, respectively), than that in the control group (0.30 ± 0.08 mm, P < 0.01). Differences in the intimal-medial thickness among the groups were associated with the magnitude of cellular proliferating activity. The graft patency ratio (100 %) was higher in the P(LA/CL) group than that in the nonabsorbable and control groups (72.2 and 63.6%, respectively, P < 0.05). CONCLUSIONS: The biodegradable P(LA/CL) external mesh stent improved vein graft patency for 12 months and prevented vein graft dilatation and intimal hyperplasia associated with suppressed neointimal layer cellular proliferating activity.

Development of an ultrasound microscope combined with optical microscope for multiparametric characterization of a single cell.

Biomechanics of the cell has been gathering much attention because it affects the pathological status in atherosclerosis and cancer. In the present study, an ultrasound microscope system combined with optical microscope for characterization of a single cell with multiple ultrasound parameters was developed. The central frequency of the transducer was 375 MHz and the scan area was 80 × 80 µm with up to 200 × 200 sampling points. An inverted optical microscope was incorporated in the design of the system, allowing for simultaneous optical observations of cultured cells. Two-dimensional mapping of multiple ultrasound parameters, such as sound speed, attenuation, and acoustic impedance, as well as the thickness, density, and bulk modulus of specimen/cell under investigation, etc., was realized by the system. Sound speed and thickness of a 3T3-L1 fibroblast cell were successfully obtained by the system. The ultrasound microscope system combined with optical microscope further enhances our understanding of cellular biomechanics.

Numerical analysis of acoustic impedance microscope utilizing acoustic lens transducer to examine cultured cells.

A new technique is proposed for non-contact quantitative cell observation using focused ultrasonic waves. This technique interprets acoustic reflection intensity into the characteristic acoustic impedance of the biological cell. The cells are cultured on a plastic film substrate. A focused acoustic beam is transmitted through the substrate to its interface with the cell. A two-dimensional (2-D) reflection intensity profile is obtained by scanning the focal point along the interface. A reference substance is observed under the same conditions. These two reflections are compared and interpreted into the characteristic acoustic impedance of the cell based on a calibration curve that was created prior to the observation. To create the calibration curve, a numerical analysis of the sound field is performed using Fourier Transforms and is verified using several saline solutions. Because the cells are suspended by two plastic films, no contamination is introduced during the observation. In a practical observation, a sapphire lens transducer with a center frequency of 300 MHz was employed using ZnO thin film. The objects studied were co-cultured rat-derived glial (astrocyte) cells and glioma cells. The result was the clear observation of the internal structure of the cells. The acoustic impedance of the cells was spreading between 1.62 and 1.72 MNs/m(3). Cytoskeleton was indicated by high acoustic impedance. The introduction of cytochalasin-B led to a significant reduction in the acoustic impedance of the glioma cells; its effect on the glial cells was less significant. It is believed that this non-contact observation method will be useful for continuous cell inspections.

Preventing effects of joint contracture by high molecular weight hyaluronan injections in a rat immobilized knee model.

PURPOSE: To elucidate preventive effects of high molecular weight hyaluronan (HMWHA) on the joint capsule of immobilized knees in rats. MATERIALS AND METHODS: Unilateral knee joints of rats were immobilized with an internal fixator. Either 50 µl of HMWHA (Im-HA group) or 50 µl of saline (control group) was administered intra-articularly once a week after surgery. Sagittal sections were prepared from the medial midcondylar region of the knee joints and assessed by histological, histomorphometric, and immunohistochemical methods. Gene expressions related to inflammation, fibrotic conditions, and hypoxia were evaluated by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Tissue elasticity of the capsule from both groups was examined using a scanning acoustic microscope (SAM). RESULTS: CD68 positive cells decreased in adhesion areas of the synovial membrane after 1 week in both groups. The length of the superficial layer in the synovial membrane of the Im-HA group was significantly longer than those in the control group over a period of 4 to 8 weeks with significantly small numbers of CD68 positive cells. The gene expressions of IL-6, IL-1ß, TGF-ß, CTGF, COL1a1, COL3a1, SPARC, and HIF1-α were significantly lower in the Im-HA group compared to those in the control group. The sound speed of the anterior and posterior synovial membrane increased significantly (a reduction in elasticity) in the control group compared to those in the Im-HA group during weeks 1 to 4. CONCLUSIONS: This study demonstrated that HMWHA injections suppressed inflammatory, fibrotic, and hypoxic conditions observed in the immobilized joint capsule.

Macrophage with gold nanorod visualized by optical-resolution and acoustic-resolution photoacoustic microscopes.

Macrophages play a key role in inflammation and they are frequently observed in vulnerable atherosclerotic plaque. In the present study, macrophages phagocytosing gold nanorod (AuNR) were observed by optical-resolution (OR) and acoustic-resolution (AR) photoacoustic microscope (PAM). The OR-PAM consisted of diode laser optically focused to 60 micron and planar ultrasonic transducer with the central frequency of 8 MHz placed under the object. AR-PAM consisted of concave ultrasonic transducer with the central frequency of 20 MHz and optical fiber through the center hole of the transducer for laser irradiation. First, PA signal from gold, silver and copper wire were measured in order to determine the best metal substrate for enhancing PA contrast. Gold generated largest PA signal. AuNR with the resonance wavelength of 1064 nm was co-cultured with the macrophages for phagocytosis. PA signal was successfully detected from macrophages with AuNR by both OR-PAM and AR-PAM. PA imaging of the macrophages with AuNR indicates inflammation in the vulnerable plaque and AR-PAM method would be applicable for clinical settings.

Coronary artery atherectomy reduces plaque shear strains: an endovascular elastography imaging study.

Mechanical response and properties of the arterial wall can be used to identify the biomechanical instability of plaques and predict their vulnerability to rupture. Shear strain elastography (SSE) is proposed to identify vulnerable plaque features attributed to mechanical structural heterogeneities. The aims of this study were: 1) to report on the potential of SSE to identify atherosclerotic plaques; and 2) to use SSE maps to highlight biomechanical changes in lesion characteristics after directional coronary atherectomy (DCA) interventions. For this purpose, SSE was imaged using in vivo intravascular ultrasound (IVUS) radio-frequency data collected from 12 atherosclerotic patients before and after DCA intervention. Coronary atherosclerotic plaques (pre-DCA) showed high SSE magnitudes with large affected areas. There were good correlations between SSE levels and soft plaque content (i.e., cellular fibrosis, thrombosis and fibrin) (mean |SSE| vs. soft plaque content: r = 0.82, p < 0.01). Significant differences were noticed between SSE images before and after DCA. Stable arteries (post-DCA) exhibited lower values than pre-DCA vessels (e.g., pre-DCA: mean |SSE| = 3.9 ± 0.2% vs. 1.1 ± 0.2% post-DCA, p < 0.001). Furthermore, SSE magnitude was statistically higher in plaques with a high level of inflammation (e.g., mean |SSE| had values of 4.8 ± 0.4% in plaques with high inflammation, whereas it was reduced to 1.8 ± 0.2% with no inflammation, p < 0.01). This study demonstrates the potential of the IVUS-based SSE technique to detect vulnerable plaques in vivo.

Contribution of oxidative stress to the degeneration of rotator cuff entheses.

BACKGROUND: Rotator cuff degeneration is one of the multiple factors that lead to rotator cuff tears; however, the precise mechanism of such degeneration still remains unclear. In this study, we investigated the supraspinatus tendon enthesis to clarify the link between rotator cuff degeneration and oxidative stress in antioxidant enzyme superoxide dismutase 1 (Sod1)-deficient mice (Sod1(-/-)). METHODS: The supraspinatus tendon and humeral head were isolated and fixed to prepare histologic sections from wild-type and Sod1(-/-) male mice at 20 weeks of age. Hematoxylin-eosin staining was performed to assess the histomorphologic structure. To investigate the collagen fibers, we examined spatially aligned collagen fibers using a polarizing microscope and assessed the amount of collagen using immunohistochemical staining. To analyze the tissue elasticity, we measured the tissue acoustic properties using scanning acoustic microscopy. RESULTS: The Sod1(-/-) mice showed histologic changes, such as a misaligned 4-layered structure and fragmented tidemark, in the enthesis. Sod1 loss also decreased the amount of brightly diffracted light and type I collagen, indicating collagen downregulation. The scanning acoustic microscopy analysis showed that the speed and attenuation of sound were increased in the nonmineralized fibrocartilage of the Sod1(-/-) mice, suggesting decreased mechanical properties in the supraspinatus enthesis. CONCLUSION: Sod1 deficiency-induced degeneration is associated with impaired elasticity in the supraspinatus tendon enthesis, recapitulating human rotator cuff degeneration. These results suggest that intracellular oxidative stress contributes to the degeneration of rotator cuff entheses.

Joint haemorrhage partly accelerated immobilization-induced synovial adhesions and capsular shortening in rats.

PURPOSE: To elucidate the effects of intra-articular haemorrhage on the joint capsule of immobilized knees in rats. METHODS: The unilateral knee joints were immobilized using a plastic plate and screws. Sham operated rats had only screws inserted. A single injection of fresh autologous blood was given postoperatively into the knee joints of the immobilized blood injection (Im-B) and the Sham blood injection (Sm-B) groups. Normal saline was administered for the immobilized-saline injection (Im-S) group. Sagittal sections were prepared from the medial midcondylar region of the knee and assessed with histological, histomorphometric, and immunohistochemical methods. The range of motion (ROM) was measured, and the mechanical property of the capsule was assessed by scanning acoustic microscope. RESULTS: Absorption of the injected blood was delayed and made severe adhesions in the Im-B group. The length of the synovial membrane in the Im-B group was significantly shorter than that of the other groups. The ROM was significantly restricted in the Im-B group compared with the other groups. The elasticity of the posterior capsule in the Im-B group was significantly lower than that in the Sm-B group. Iron deposition was observed in the Im-B and Sm-B groups. Strong immunoreactivities of CD68, TGF-ß1, and α-SMA were observed in the adhesion area of the Im-B group. Joint immobilization with blood injection caused severe capsular adhesion and limited range of motion. Immunostaining related to fibrosis increased with joint haemorrhage. CONCLUSION: Intra-articular haemorrhage with joint immobilization might be an accelerated risk factor for joint contracture. It is likely that leaving a haematoma inside an immobilized joint should be avoided.

"Sonocytometry" ­ novel diagnostic method of ultrasonic differentiation of cells in blood flow.

Novel diagnostic method named "sonocytometry", in which streaming blood cell is diagnosed by the reflection of high frequency ultrasound from the cell, is proposed. In the present study, the differentiation of the particle size is performed as a basic study on sonocytometry. Ultrasonic backscatter signal from either 80 or 100 µm diameter polystyrene particles was measured by an ultrasonic transducer with the central frequency of 30 MHz. The spectrum of the reflected signal showed different characteristics according to the particle diameter. Theoretical value of backscatter was calculated by Faran-Hickling model and the correlation coefficient of measured and theoretical value by varying the spherical diameter showed the local maximum value at either 80 or 100 µm diameter. The principle was also validated on the streaming particles in a flow channel. The method successfully classified the particle size. Sonocytometry would be clinically applied for diagnosis of malaria or leukemia.

High-resolution ultrasound imaging of human skin in vivo by using three-dimensional ultrasound microscopy.

Observing the morphology of human skin is important in the diagnosis of skin cancer and inflammation and in the assessment of skin aging. High-frequency ultrasound imaging provides high spatial resolution of the deep layers of the skin, which cannot be visualized by optical methods. The objectives of the present study were to develop a three-dimensional (3-D) ultrasound microscope and to observe the morphology of normal human skin in vivo. A concave polyvinylidene fluoride transducer with a central frequency of 120 MHz was excited using an electric pulse generated by semiconductor switching. The transducer was scanned two-dimensionally by using two linear motors on the region-of-interest and the ultrasonic reflection was digitized with 2-GHz sampling. Consecutive B-mode images perpendicular to the skin surface were reconstructed to generate multiplanar reconstructed images and 3-D volume-rendering images clearly showing microstructures such as sebaceous glands and hair follicles. The 3-D ultrasound microscope could be used to successfully image the morphology of human skin noninvasively and may provide important information on skin structure.

Echogenicity in transrectal ultrasound is determined by sound speed of prostate tissue components.

Typically, conventional transrectal ultrasound (TRUS) imaging of the cancer tissue is hypoechoic in echo texture. However, TRUS does not reliably distinguish between cancerous and non-cancerous tissue in the prostate. In the present study, sound speed of prostate needle biopsy specimens were measured by ultrasound speed microscope (USM) to construct a database for interpreting clinical TRUS images. Biopsy specimens were formalin-fixed and sectioned approximately 5 µm in thickness. They were mounted on glass slides without cover slips. The ultrasonic transducer with the central frequency of 120 MHz was mechanically scanned over the specimen to measure sound speed distribution. Echo intensity of TRUS images were qualitatively classified into three categories; hyperechoic, iso-echoic and hypoechoic areas. Sound speed was 1596.9 ± 28.2 m/s in hyperechoic, 1571.2 ± 35.8 m/s in iso-echoic and 1562.6 ± 35.1 m/s in hypoechoic area, respectively. However, echo intensity showed no significant relationship to malignancy of prostatic tissue. Echo intensity of TRUS is significantly affected with tissue components and USM findings would provide important information for interpretation of TRUS images.

Ultrasonic tissue characterization of prostate biopsy tissues by ultrasound speed microscope.

Ultrasound speed microscope was developed for quantitative measurement of ultrasonic parameters of soft tissues. The system can measure the ultrasonic attenuation and sound speed in the tissue using fast Fourier transform of a single pulsed wave instead of burst waves used in conventional acoustic microscopy. Prostate biopsy tissues were formalin-fixed and sectioned approximately 5-6 µm in thickness. They were mounted on glass slides without cover slips. The ultrasonic transducer was mechanically scanned over the specimen. Attenuation was 1.42 ± 0.08 dB/mm and the sound speed was 1584 ± 12 m/s in prostatic cancer while both values were 1.86 ± 0.14 dB/mm and 1614 ± 30 m/s in normal prostate. The basic measurements of ultrasonic properties would help understanding the interpretation of clinical echography in diagnosis of prostate cancer.

Effect of estrogen on tissue elasticity of the ligament proper in rabbit anterior cruciate ligament: measurements using scanning acoustic microscopy.

BACKGROUND: Previous epidemiological studies revealed that anterior cruciate ligament (ACL) injuries were more frequently seen in female athletes than in male athletes. To elucidate the pathogenetic roles of estrogen in ACL ruptures, the elasticity of ACL tissue was measured using a scanning acoustic microscope (SAM) in an estrogen-controlled animal model. METHODS: A total of 40 ovariectomized Japanese white rabbits were randomly divided into four groups according to the administered dose of 17beta-estradiol (groups L, M, H, and C). Injection of 17beta-estradiol was performed 1, 2, 3, and 4 weeks after surgery, and doses in groups L, M, and H were 50, 100, and 500 microg/kg, respectively. Group C received no estradiol. Only groups L, M, and C were used for current analyses because their mean serum estrogen levels were within the physiological range (groups C, L, M, and H: 37, 50, 60, and 231 pg/ml, respectively). Five weeks after ovariectomy, the lateral portion of the ligament was harvested. Specimens were fixed with 10% neutralized formalin and embedded in paraffin. Then, 10 mum thick sections were cut perpendicular to the ligament fibers for routine histological staining and measurement with SAM. RESULTS: The mean tissue sound speeds of groups C, L, and M were 1727 +/- 32, 1683 +/- 53, and 1665 +/- 63 m/s, respectively. Group M presented significantly lower tissue sound speed than group C (P = 0.021). Furthermore, a negative correlation was found between the mean serum estrogen level and mean tissue sound speed of the ACL among all animals in groups C, L, and M (r = 0.47, P = 0.016). CONCLUSION: The results of the present study indicated that estrogen altered the tissue elasticity of rabbit ACL. Estrogen may constitute one of the pathogenetic factors in ACL rupture in female athletes.