One-year volume growth of abdominal aortic aneurysms measured by extended field-of-view ultrasound.

BACKGROUND: Measurement of volume has the potential to detect subtle growth not recognized in the current surveillance paradigm of abdominal aortic aneurysms (AAAs). Currently available three-dimensional ultrasound allows for estimation of AAA volume, but for most patients, the AAA extends beyond the ultrasound field-of-view and only allows visualization of a partial AAA volume. A new extended field-of-view three-dimensional ultrasound protocol (XFoV US) has been found to improve the proportion of patients with visualization of the full AAA volume. METHODS: To investigate the applicability of the XFoV US protocol in estimating AAA volume growth in follow-up, 86 patients with AAAs were recruited from the surveillance program at a university hospital. All were imaged by XFoV US at baseline and at one-year follow-up. RESULTS: Assessment of full volume, based on visualization of the AAA neck and bifurcation at both baseline and one-year follow-up, was achieved in 67/86 (78%) of patients. One-year mean growth in maximum diameter was 2.8 mm (6%/year), in centerline length 2.9 mm (4%/year), and in volume 15.9 mL (19%/year). In 17/67 (25%) of patients, volume growth was detected in diameter-stable AAAs. Baseline XFoV US volume was associated with one-year AAA volume growth, while, conversely, maximum baseline diameter was not associated with one-year AAA diameter growth. CONCLUSIONS: This study concludes that the XFoV US protocol provides a safe and repeatable modality for assessing AAA volume growth, and that AAA volume is a promising predictive measure of AAA growth.

Cellular Antioxidant Effect of an Aronia Extract and Its Polyphenolic Fractions Enriched in Proanthocyanidins, Phenolic Acids, and Anthocyanins.

Oxidative stress and chronic inflammation contribute to some chronic diseases. Aronia berries are rich in polyphenols. The aim of the present study was to characterize the cellular antioxidant effect of an aronia extract to reflect the potential physiological in vivo effect. Cellular in vitro assays in three cell lines (Caco-2, HepG2, and SH-SY5Y) were used to measure the antioxidant effect of AE, in three enriched polyphenolic fractions (A1: anthocyanins and phenolic acids; A2: oligomeric proanthocyanidins; A3: polymeric proanthocyanidins), pure polyphenols and microbial metabolites. Both direct (intracellular and membrane radical scavenging, catalase-like effect) and indirect (NRF2/ARE) antioxidant effects were assessed. AE exerted an intracellular free radical scavenging activity in the three cell lines, and A2 and A3 fractions showed a higher effect in HepG2 and Caco-2 cells. AE also exhibited a catalase-like activity, with the A3 fraction having a significant higher activity. Only A1 fraction activated the NRF2/ARE pathway. Quercetin and caffeic acid are the most potent antioxidant polyphenols, whereas cyanidin and 5-(3',4'-dihydroxyphenyl)-γ-valerolactone showed the highest antioxidant effect among polyphenol metabolites. AE rich in polyphenols possesses broad cellular antioxidant effects, and proanthocyanidins are major contributors. Polyphenol metabolites may contribute to the overall antioxidant effect of such extract in vivo.

Cell-Based Antioxidant Properties and Synergistic Effects of Natural Plant and Algal Extracts Pre and Post Intestinal Barrier Transport.

In this work, both direct and indirect cell-based antioxidant profiles were established for 27 plant extracts and 1 algal extract. To evaluate the direct antioxidant effects, fluorescent AOP1 cell assay was utilized, which measures the ability of different samples to neutralize intracellular free radicals produced by a cell-based photo-induction process. As the intestinal barrier is the first cell line crossed by the product, dose response curves obtained from Caco-2 cells were used to establish EC50 values for 26 out of the 28 natural extracts. Among them, 11 extracts from Vitis, Hamamelis, Syzygium, Helichrysum, Ilex and Ribes genera showed remarkable EC50s in the range of 10 µg/mL. In addition to this, a synergistic effect was found when combinations of the most potent extracts (S. aromaticum, H. italicum, H. virginiana, V. vinifera) were utilized compared to extracts alone. Indirect antioxidant activities (i.e., the ability of cells to trigger antioxidant defenses) were studied using the ARE/Nrf2 luminescence reporter-gene assay in HepG2 cells, as liver is the first organ crossed by an edible ingredient once it enters in the bloodstream. Twelve extracts were subjected to an intestinal epithelial barrier passage in order to partially mimic intestinal absorption and show whether basolateral compartments could maintain direct or indirect antioxidant properties. Using postepithelial barrier samples and HepG2 cells as a target model, we demonstrate that indirect antioxidant activities are maintained for three extracts, S. aromaticum, H. virginiana and H. italicum. Our experimental work also confirms the synergistic effects of combinations of post-intestinal barrier compartments issued from apical treatment with these three extracts. By combining cell-based assays together with an intestinal absorption process, this study demonstrates the power of cell systems to address the issue of antioxidant effects in humans.

Full-Volume Assessment of Abdominal Aortic Aneurysm by Improved-Field-of-View 3-D Ultrasound Performs Comparably to Computed Tomographic Angiography.

Three-dimensional ultrasound (US) of abdominal aortic aneurysms (AAAs) is limited by the field-of-view of the 3D-US transducer. To obtain an extended field-of-view (XFoV), two transducer navigation system-assisted US protocols have been developed: XFoV-2D and XFoV-3D. In this study, the XFoV US protocols were compared with the currently available 3D-US protocol with standard field-of-view (FoV-st) and the established gold standard, computed tomography angiography (CTA). A total of 65 patients with AAA were included, and AAA imaging was processed offline with prototype software. The novel XFoV-2D and XFoV-3D protocols allowed for assessment of full AAA volume in significantly more patients (45/65 [69%] and 43/65 [66%], respectively), compared with the current 3D-US standard, FoV-st (30/65 [46%] patients). The mean difference in AAA volume estimation between each XFoV US protocol and 3-D CTA differed significantly (XFoV-2D: 16.9 mL, XFoV-3D: 7.6 mL, p = 0.002), indicating that XFoV-3D agreed best with 3D-CTA. No significant difference was found in the variance of full AAA volume quantification between each XFoV US protocol and CTA (p = 0.49). It is concluded that the XFoV US protocols improved the generation of full AAA volumes compared with the currently available 3D-US technology, with AAA volume estimates comparable to CTA estimates.

Full-Volume Assessment of Abdominal Aortic Aneurysms by 3-D Ultrasound and Magnetic Tracking.

Volume assessment of abdominal aortic aneurysms (AAAs) using 3-D ultrasound (US) is an innovative technique reporting good agreement with computed tomography angiography. One major limitation of the current 3-D US technique is a limited field of view, allowing full AAA acquisition in only 60% of patients. This study presents two new US acquisition protocols using magnetic field tracking, providing an "extended field of view" (XFoV-2-D and XFoV-3-D) with the aim of including both the aortic bifurcation and neck for full-volume assessment, and compares these methods with the current standard 3-D US protocol and with computed tomography angiography. A total of 20 AAA patients were included and underwent the current standard 3-D US protocol and the two novel 3-D US "extended field of view" protocols. Four patients were excluded from further analysis because of low image quality, leaving 16 patients eligible for analysis. Full AAA volume was achieved in 8 patients (50%) using the standard 3-D US protocol, in 11 patients (69%) with the XFoV-2-D protocol and in 13 patients (81%) with the XFoV-3-D protocol. In conclusion, this article describes two new and feasible US protocols applicable for full-AAA-volume estimation in most patients and should initiate further research into the added value of full volume in AAA surveillance.

AOP1, a New Live Cell Assay for the Direct and Quantitative Measure of Intracellular Antioxidant Effects.

Taking advantage of Light Up Cell System (LUCS) technology, which allows for fine monitoring of reactive oxygen species (ROS) production inside live cells, a new assay called Anti Oxidant Power 1 (AOP1) was developed to specifically measure ROS and/or free-radical scavenging effects inside living cells. This method is quantitative and EC50s obtained from AOP1 dose-response experiments were determined in order to classify the intracellular antioxidant efficacy of 15 well known antioxidant compounds with different hydrophilic properties. Six of them (epigallocatechin gallate, quercetin, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), ethoxyquin, resveratrol) gave EC50s in the range of 7-64 µM, four (Trolox, catechin, epicatechin, EUK134) in the range of 0.14 to 1 mM, and 5 (sulforaphane, astaxanthin, α- and γ-tocopherols, vitamin E acetate) showed only partial or no effect. Interestingly, effects with measurable EC50s were observed for compounds with hydrophilic properties (LogP ≤ 5.3), while all antioxidants known to act at the plasma membrane level (LogP ≥ 10.3) had partial or no effect. Sulforaphane, a hydrophilic but strict Keap1/Nrf2 pathway enhancer, did not show any effect either. Importantly, AOP1 assay captures both antioxidant and prooxidant effects. Taken together, these results led us to the conclusion that AOP1 assay measures antioxidant effect of compounds that selectively enter the cell, and act as free radical scavengers in the cytosol and/or nucleus level.

CT and 3D-ultrasound registration for spatial comparison of post-EVAR abdominal aortic aneurysm measurements: A cross-sectional study.

OBJECTIVE: The aim of the present study is to provide a methodology to register volumes of stented abdominal aortic aneurysm, imaged by 3D-US and CT modalities. After registration, the method enables to compare the spatial location of measurements and AAA size in a common coordinate system. METHODS: The study is cross-sectional and compares volumes acquired within a few days, in order to eliminate changes due to the evolution of AAA shape after treatment. The key element is to rely on stent alignment to register the CT and 3D-US volumes, providing access to a patient-specific common spatial coordinate system. In parallel, 3D segmentations are performed and used to extract multi-planar reconstructions at the locations of maximum diameter in each modality. The positions of the planes extracted in each modality, and the AAA diameters are finally compared in the common coordinate system. RESULTS: Results are validated on a database of 52 patients. After registrations, results show a mean inter-planar distance of 6.4 ±â€¯4.5 mm and a mean inter-planar angle of 10.2°±6.7 between CT and 3D-US multi-planar reconstructions. Bland-Altman comparisons of diameter measurements in the CT, US and non-registered volumes are respectively 5.1 ±â€¯2.8, 3.9 ±â€¯2.8, 4.6 ±â€¯3.0 mm. CONCLUSION: The proposed approach provides both visual and quantitative validations of measurements extracted from multi-modality images of the same pathology, in terms of spatial relationship and diameters. SIGNIFICANCE: The present work provides additional confidence in the use of 3D-US without CT for the follow-up of patients with abdominal aortic aneurysms after endovascular treatment.

A clinical validation study for the feasibility and reliability of three-dimensional ultrasound-ultrasound automatic image registration.

PURPOSE: The purpose of our study was to assess the feasibility and reliability of 3D ultrasound-ultrasound (US-US) automatic registration-based analysis of the hepatic vessel tree (VT) (3D VT-based automatic registration) in clinical applications. MATERIALS AND METHODS: A total of 70 pairs of 3D ultrasound data were acquired from the livers of 10 healthy volunteers enrolled in the study. An automatic registration method was applied to the acquired volumetric data pairs, and anatomic landmarks were picked by an experienced sonographer as 'ground truth'. The influences of respiration phase, subject posture, and liver lobe on data acquisition and scan volumetric angle on the registration accuracy and robustness were investigated. The registration time, success rate, median registration error distance, and sonographer's subjective feedback were assessed. RESULTS: The time required for the 3D VT-based automatic registration was approximately 15∼20 s. Overall, the success rate for the hepatic vessel-based registration was 71% (50/70), and the median registration error distance was 1.72 mm (0.57∼4.71 mm). When the influential factors were well controlled, the optimal registration accuracy (median registration error distance = 1.22 mm) could be obtained with an excellent success rate of 100% (10/10). According to the subjective assessment of the sonographer, over 90% (45/50) of the automatic registration results were not inferior to the ground truth. Among them, 42% (21/50) were superior to the fusion results from the ground truth. CONCLUSIONS: The results suggest that the 3D VT-based automatic registration is feasible and reliable and has potential for guidance and evaluation of intraoperative ablation of hepatocellular carcinoma.

Accuracy of measuring mitral annular velocity by 2D speckle tracking imaging.

BACKGROUND: Recent developments in 2D speckle tracking imaging allow not only measurements of regional myocardial strain, but also velocities of the mitral annulus. The aim of this study was to determine the accuracy of speckle tracking derived mitral annulus velocity compared with conventional pulsed wave Doppler measurements. METHODS: 2D speckle tracking was acquired from the apical 4-chamber view (QLab, Speckle SQ, Philips, Andover, MA) in 169 subjects. While using texture tracking, two small regions of interest (ROIs) were placed in the septal (IVS) and lateral corners (LAT) of the mitral annulus. The software automatically tracked the ROIs frame-by-frame, yielding regional mean velocity curves of the mitral annulus throughout the cardiac cycle (synthetic pulsed wave Doppler; SPW). From these curves, peak systolic, early- and late-diastolic velocities of the mitral annulus (S'-SPW, E'-SPW, and A'-SPW) were measured. Peak systolic, early- and late-diastolic velocity in the mitral annulus (S', E', and A') by conventional pulsed wave tissue Doppler tracing were also obtained. RESULTS: Adequate ROI tracking was observed in 150/169 subjects in IVS and 139/169 subjects in LAT of the mitral annulus. All annular velocities derived from SPW were significantly lower than corresponding velocities obtained from conventional method in both IVS and LAT regions of the mitral annulus. However, significant correlation between S' (E', A')-SPW and S' (E', A') was observed. In particular, a good correlation between E'-SPW and E' was noted in both IVS (r=0.89, P<0.001) and LAT (r=0.85, P<0.001) regions of the mitral annulus. If we defined E/E'-SPW in IVS>26 for predicting E/E' in IVS>15, sensitivity, specificity, and accuracy were 83%, 97%, and 94%, respectively. E/E'-SPW in LAT>13 had a 94% sensitivity, 92% specificity, and 93% accuracy for predicting E/E' in LAT>10. CONCLUSIONS: The values of annular velocities by SPW were significantly lower compared to those assessed by traditional tissue velocities. However, new cut-off values of E/E'-SPW for predicting elevated LV filling pressure highly correlated with traditional parameters. 2D speckle tracking imaging provides another strategy for evaluating LV filling pressures.