Dynamic Ultrasound Assessment of Median Nerve Mobility Changes Following Corticosteroid Injection and Carpal Tunnel Release in Patients With Carpal Tunnel Syndrome.

Decreased median nerve (MN) mobility was found in patients with carpal tunnel syndrome (CTS) and was inversely associated with symptom severity. It is unclear whether MN mobility can be restored with interventions. This study compared the changes in MN mobility and clinical outcomes after interventions. Forty-six patients with CTS received an injection (n = 23) or surgery (n = 23). Clinical outcomes [Visual Analogue Scale; Boston Carpal Tunnel Questionnaire (BCTQ), which includes the Symptom Severity Scale and Functional Status Scale; median nerve cross-sectional area; and dynamic ultrasound MN mobility parameters (amplitude, and R2 value and curvature of the fitted curves of MN transverse sliding)] were assessed at baseline and 12 weeks after the interventions. At baseline, the BCTQ-Functional Status Scale and median nerve cross-sectional area showed significant inter-treatment differences. At 12 weeks, both treatments had significant improvements in BCTQ-Symptom Severity Scale and Visual Analogue Scale scores and median nerve cross-sectional area, but with greater improvements in BCTQ-Functional Status Scale scores observed in those who received surgery than in those who received injections. MN mobility was insignificantly affected by both treatments. The additional application of dynamic ultrasound evaluation may help to discriminate the severity of CTS initially; however, its prognostic value to predict clinical outcomes after interventions in patients with CTS is limited.

Improvement of light penetration in biological tissue using an ultrasound-induced heating tunnel.

The major obstacles of optical imaging and photothermal therapy in biomedical applications is the strong scattering of light within biological tissues resulting in light defocusing and limited penetration. In this study, we propose high intensity focused ultrasound (HIFU)-induced heating tunnel to reduce the photon scattering. To verify our idea, Monte Carlo simulation and intralipid-phantom experiments were conducted. The results show that the thermal effect created by HIFU could improve the light fluence at the targeted region by 3% in both simulation and phantom experiments. Owing to the fluence increase, similar results can also be found in the photoacoustic experiments. In conclusion, our proposed method shows a noninvasive way to increase the light delivery efficiency in turbid medium. It is expected that our finding has a potential for improving the focal light delivery in photoacoustic imaging and photothermal therapy.

Hepatic Steatosis Assessment with Ultrasound Small-Window Entropy Imaging.

Nonalcoholic fatty liver disease is a type of hepatic steatosis that is not only associated with critical metabolic risk factors but can also result in advanced liver diseases. Ultrasound parametric imaging, which is based on statistical models, assesses fatty liver changes, using quantitative visualization of hepatic-steatosis-caused variations in the statistical properties of backscattered signals. One constraint with using statistical models in ultrasound imaging is that ultrasound data must conform to the distribution employed. Small-window entropy imaging was recently proposed as a non-model-based parametric imaging technique with physical meanings of backscattered statistics. In this study, we explored the feasibility of using small-window entropy imaging in the assessment of fatty liver disease and evaluated its performance through comparisons with parametric imaging based on the Nakagami distribution model (currently the most frequently used statistical model). Liver donors (n = 53) and patients (n = 142) were recruited to evaluate hepatic fat fractions (HFFs), using magnetic resonance spectroscopy and to evaluate the stages of fatty liver disease (normal, mild, moderate and severe), using liver biopsy with histopathology. Livers were scanned using a 3-MHz ultrasound to construct B-mode, small-window entropy and Nakagami images to correlate with HFF analyses and fatty liver stages. The diagnostic values of the imaging methods were evaluated using receiver operating characteristic curves. The results demonstrated that the entropy value obtained using small-window entropy imaging correlated well with log10(HFF), with a correlation coefficient r = 0.74, which was higher than those obtained for the B-scan and Nakagami images. Moreover, small-window entropy imaging also resulted in the highest area under the receiver operating characteristic curve (0.80 for stages equal to or more severe than mild; 0.90 for equal to or more severe than moderate; 0.89 for severe), which indicated that non-model-based entropy imaging-using the small-window technique-performs more favorably than other techniques in fatty liver assessment.

Assessment of temporary cerebral effects induced by focused ultrasound with optical coherence tomography angiography.

Focused ultrasound (FUS) in combination with microbubbles temporally and locally increases the permeability of the blood-brain barrier (BBB) for facilitating drug delivery. However, the temporary effects of FUS on the brain microstructure and microcirculation need to be addressed. We used label-free optical coherence tomography (OCT) and OCT angiography (OCTA) to investigate the morphological and microcirculation changes in mouse brains due to FUS exposure at different power levels. Additionally, the recovery progress of the induced effects was studied. The results show that FUS exposure causes cerebral vessel dilation and can be identified and quantitatively analyzed via OCT/OCTA. Micro-hemorrhages can be detected when an excessive FUS exposure power is applied, causing the degradation of OCTA signal owing to strong scattering by leaked red blood cells (RBCs) and weaker backscattered intensity from RBCs in vessels. The vessel dilation effect due to FUS exposure was found to abate in several hours. This study demonstrates that the FUS-induced cerebral transiently dilated effects can be in-vivo differentiated and monitored with OCTA, and shows the feasibility of using OCT/OCTA as a novel tool for long-time monitoring of cerebral vascular dynamics during FUS-BBB opening process.

Assessment of Median Nerve Mobility by Ultrasound Dynamic Imaging for Diagnosing Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy and is characterized by median nerve entrapment at the wrist and the resulting median nerve dysfunction. CTS is diagnosed clinically as the gold standard and confirmed with nerve conduction studies (NCS). Complementing NCS, ultrasound imaging could provide additional anatomical information on pathological and motion changes of the median nerve. The purpose of this study was to estimate the transverse sliding patterns of the median nerve during finger movements by analyzing ultrasound dynamic images to distinguish between normal subjects and CTS patients. Transverse ultrasound images were acquired, and a speckle-tracking algorithm was used to determine the lateral displacements of the median nerve in radial-ulnar plane in B-mode images utilizing the multilevel block-sum pyramid algorithm and averaging. All of the averaged lateral displacements at separate acquisition times within a single flexion-extension cycle were accumulated to obtain the cumulative lateral displacements, which were curve-fitted with a second-order polynomial function. The fitted curve was regarded as the transverse sliding pattern of the median nerve. The R2 value, curvature, and amplitude of the fitted curves were computed to evaluate the goodness, variation and maximum value of the fit, respectively. Box plots, the receiver operating characteristic (ROC) curve, and a fuzzy c-means clustering algorithm were utilized for statistical analysis. The transverse sliding of the median nerve during finger movements was greater and had a steeper fitted curve in the normal subjects than in the patients with mild or severe CTS. The temporal changes in transverse sliding of the median nerve within the carpal tunnel were found to be correlated with the presence of CTS and its severity. The representative transverse sliding patterns of the median nerve during finger movements were demonstrated to be useful for quantitatively estimating median nerve dysfunction in CTS patients.

Dynamic perfusion assessment by contrast-enhanced ultrasound in blood-brain barrier disruption.

Recently, blood-brain barrier disruption (BBBD) has been performed by focused ultrasound (FUS) combining with microbubbles (MBs). The outcome of BBBD enhances local drug or gene delivery for improving the treatment efficiency of brain diseases. However, over-excitation of FUS may cause brain damage such as shutdown blood flow, intracerebral hemorrhage and brain edema. Therefore, it is essential to develop a an imaging system to assess dynamic perfusion changes during FUS-induced BBBD process. Here, we used the high-frequency destruction/reperfusion contrast-enhanced imaging technique to observe the cerebral perfusion under the cases of with/without hemorrhage in BBBD procedure. The BBB was disrupted by a 2.25 MHz FUS combining with MBs at 0.5-0.7 MPa (pulse repetition frequency: 1 Hz, pulse length: 1 ms, sonication time: 60 s). The results showed that the velocity of blood flow decreased after BBBD induced by FUS sonication. Particularly, the plateau of time-intensity curve was higher than prior to MBs destruction at 20 s after sonication and the blood flow would be obstructed due to the blood coagulates at 60s after sonication. The pattern of hemorrhagic damage caused by FUS can be monitored by the TIC. In addition, the location of blood flow velocity decrease was consistent with the areas of BBBD and the variation of blood flow depends on the applied acoustic pressure. In conclusion, the blood flow velocity changes have potential as an in vivo tool for quantifying the extent of the FUS-induced BBBD and detecting intracerebral hemorrhage occurrence.

Assessment of tumor vasculature for diagnostic and therapeutic applications in a mouse model in vivo using 25-MHz power Doppler imaging.

OBJECTIVE: The blood flow rate in the microcirculation associated with angiogenesis plays an important role in the progression and treatment of cancer. Since the microvascular status of tumor vessels can yield useful clinical information, assessing changes in the tumor microcirculation could be particularly helpful for tumor evaluation and treatment planning. METHODS: In this study we used a self-developed 25-MHz ultrasound imaging system with a spatial resolution of 150 µm for assessing tumor-microcirculation development and the pattern of the vasculature in three tumor-bearing mice in vivo based on power Doppler images. The total Doppler power (DP) and color pixel density (CPD) revealed the presence of functional vessels distributed throughout a tumor volume. The vasculature distributions in the core and periphery were compared to the regulation of vasculature function, which facilitated determination of when the tumor grew rapidly. RESULTS: The data obtained from a quantified analysis of power Doppler images indicated that the tumor vascularity initially increased throughout the tumor. Both DP and CPD increased rapidly in the tumor periphery when the tumor volume exceeded 10mm(3). CONCLUSION: Our preclinical findings suggest that power Doppler imaging could be useful for detecting the changes in tumor vascular perfusion and for determining the optimal treatment timing when a tumor begins its rapid volumetric growth.

Microcirculation volumetric flow assessment using high-resolution, contrast-assisted images.

To improve the resolution of contrast-assisted imaging systems, we previously developed a 25-MHz microbubbles-destruction/replenishment imaging system with a spatial resolution of 160 X 160 microm. The goal of the present study was to propose a new approach for functionally evaluating the microvascular volumetric blood flow based on this high-frequency, ultrasound imaging system. The approach includes locating the perfusion area and estimating the blood flow velocity therein. Because the correlation changes between before and after microbubble destruction in two adjacent images, a correlated-based approach was introduced to detect the blood perfusion area. We also have derived a new sigmoid-based model for characterizing the microbubbles replenishment process. Two parameters derived from the sigmoid-based model - the rate constant and inflection time - were adopted to evaluate the blood flow velocity. This model was validated using both simulations and in vitro experiments for mean flow velocities ranging from 1 to 10 mm/s, which showed that the model was in good agreement with simulated and measured microbubble-replenishment time-intensity curves. The results indicate that the actual flow velocity is highly correlated with the estimates of the rate constant and the reciprocal of the inflection time. B-mode imaging experiments for mean flow velocities ranging from 0.4 to 2.1 mm/s were used to assess the volumetric flow in the microcirculation. The results indicated the high correlation between the actual volumetric flow rate and the product of the estimated perfusion area and rate constant, and the reciprocal of the inflection time. We also found that the boundary of the microbubble destruction volume significantly affected estimations of the flow velocity. The perfusion area can be located, and the corresponding flow velocity can be estimated simultaneously in a one-stage, microbubble-destruction/replenishment process, which makes the assessment of the volumetric bloo- d flow in the microcirculation feasible using a real-time, high-frequency ultrasound system.

The correlation-based algorithm to perfusion assessment in ultrasound image.

A high frequency contrast-assisted destruction/reperfusion imaging system has been developed to improve image resolution in previous study. Our goal in this work is to build a fast and robust algorithm to evaluate volumetric microcirculation blood flow. The microcirculation flow rate is determined by the multiplication of perfusion area and corresponding blood flow velocity mapping. The blood flow velocity can be estimated from B-mode time-intensity curves (TICs). Two new methods, correlation-based approach (CBA) and sum-absolute-difference approach (SADA), are proposed to locate and assess perfusion area. In vitro experiments were introduced to test the performance of two approaches. The results indicate a good correlation between the actual flow rate and the estimated volumetric flow rate. Potential applications of this blood flow estimation method include high-resolution flow assessment in small animal tumor and glaucoma models and the evaluation of superficial vasculature in clinical studies.

High-resolution functional vascular assessment with ultrasound.

In order to improve the resolution of contrast-assisted imaging systems, we have created a high-frequency destruction/contrast replenishment imaging system with a spatial resolution of 160 microm x 160 microm. The system utilizes a 1-MHz cylindrically focused transducer for destruction and a 25-MHz spherically focused transducer for pulse/echo imaging. Speckle tracking and a clutter filter are applied across frames to remove the challenging physiologic motion artifacts that are obtained when imaging with a mechanically scanned transducer. Using a new estimation technique, flow constants proportional to absolute flow rate were estimated from B-mode time-intensity curves (TICs). The in vitro results indicate a correlation between the actual flow velocity and the estimated rate constant. In vivo images are presented showing blood perfusion in the ciliary processes and iris of the rabbit eye. The regions of interest (ROIs) from the ciliary processes yielded slower perfusion compared with the iris, as expected from vascular casts of the microcirculation in this region. Potential applications of this system include high-resolution perfusion assessment in small animals.