An improved Doppler model for obtaining accurate maximum blood velocities

Maximum blood velocity estimates are frequently required in diagnostic applications, including carotid stenosis evaluation, arteriovenous fistula inspection, and maternal-fetal examinations. However, the currently used methods for ultrasound measurements are inaccurate and often rely on applying heuristic thresholds to a Doppler power spectrum. A new method that uses a mathematical model to predict the correct threshold that should be used for maximum velocity measurements has recently been introduced. Although it is a valuable and deterministic tool, this method is limited to parabolic flows insonated by uniform pressure fields. In this work, a more generalized technique that overcomes such limitations is presented. The new approach, which uses an extended Doppler spectrum model, has been implemented in an experimental set-up based on a linear array probe that transmits defocused steered waves. The improved model has been validated by Field II simulations and phantom experiments on tubes with diameters between 2 mm and 8 mm. Using the spectral threshold suggested by the new model significantly higher accuracy estimates of the peak velocity can be achieved than are now clinically attained, including for narrow beams and non-parabolic velocity profiles. In particular, an accuracy of +1.2 ± 2.5 cm/s has been obtained in phantom measurements for velocities ranging from 20 to 80 cm/s. This result represents an improvement that can significantly affect the way maximum blood velocity is investigated today.     

Effects of measurement errors on refractive outcomes for pseudophakic eye based on eye model

With the Gullstrand-Le Grand eye model, the effects of various measurement errors on refractive outcomes for pseudophakic eye are studied. An equation to calculate the postoperative refractive error for pseudophakic eyes is derived. The accuracy to get a refractive error less than ca. 25 D is ±0.1 mm for the axial length, ±0.03 mm for the radius of the corneal anterior surface, ±0.12 D for the corneal power and ±0.16 mm for the postoperative anterior chamber depth (ACD). An error of 1 D in intraocular lens (IOL) power leads to a postoperative refractive error of −0.69 D. K-reading leads to a postoperative hyperopia from 0.18 to 0.74 D for eye with different refractive errors previously corrected. The constant velocity in ultrasound biometry assumption overestimates the axial length from 0.17 to 0.31 mm with actual axial length ranging from 21.31 to 32.31 mm. Errors in axial length, corneal power or radius of the corneal anterior surface and postoperative ACD play critical roles in determining the refractive outcomes. The constant-velocity assumption tends to overestimate the axial length. The change of the ratio of corneal anterior to the posterior surface is of minor importance for the overestimation of K-reading.     

Noninvasive ultrasound image guided surface wave method for measuring the wave speed and estimating the elasticity of lungs: A feasibility study

Lung diseases, such as acute respiratory distress syndrome (ARDS) and idiopathic pulmonary fibrosis (IPF), are closely associated with altered lung elastic properties. Pulmonary function testing and imaging are routinely performed for evaluating lung diseases. However, lung compliance, a measure of lung elastic properties, is rarely used in clinic, because it is invasive and provides only a global and arguably biased estimate of lung elastic properties. Current ultrasound methods also cannot be used for imaging lungs because ultrasound cannot penetrate the lung tissue. In this paper, an ultrasound image guided and surface wave based method is proposed to measure regional lung surface wave speed and estimate lung elasticity noninvasively. The method described here was not explored before to the best knowledge of the authors. Experiments in an ex vivo pig lung and an in vivo human lung pilot study are reported. The surface wave speed is measured to be 1.83 ± 0.02 m/s at 100 Hz by ultrasound for the ex vivo pig lung at 3 mmHg pressure, which is validated by an optical measurement. An in vivo human lung pilot experiment measures the surface wave speed to be 2.41 ± 0.33 m/s for the 100 Hz sinusoidal wave at total lung capacity (TLC) and 0.99 ± 0.09 m/s at functional residual capacity (FRC). These values of wave speed fall well within the range of available literature.     

In vitro ultrasonic and mechanic characterization of the modulus of elasticity of children cortical bone

The assessment of elastic properties in children’s cortical bone is a major challenge for biomechanical engineering community, more widely for health care professionals. Even with classical clinical modalities such as X-ray tomography, MRI, and/or echography, inappropriate diagnosis can result from the lack of reference values for children bone. This study provides values for elastic properties of cortical bone in children using ultrasonic and mechanical measurements, and compares them with adult values. 18 fibula samples from 8 children (5–16 years old, mean age 10.6 years old ±4.4) were compared to 16 fibula samples from 3 elderly adults (more than 65 years old). First, the dynamic modulus of elasticity (E_dyn) and Poisson’s ratio (ν) are evaluated via an ultrasonic method. Second, the static modulus of elasticity (E_sta) is estimated from a 3-point microbending test. The mean values of longitudinal and transverse wave velocities measured at 10 MHz for the children’s samples are respectively 3.2 mm/μs (±0.5) and 1.8 mm/μs (±0.1); for the elderly adults’ samples, velocities are respectively 3.5 mm/μs (±0.2) and 1.9 mm/μs (±0.09). The mean E_dyn and the mean E_sta for the children’s samples are respectively 15.5 GPa (±3.4) and 9.1 GPa (±3.5); for the elderly adults’ samples, they are respectively 16.7 GPa (±1.9) and 5.8 GPa (±2.1). E_dyn, ν and E_sta are in the same range for children’s and elderly adults’ bone without any parametric statistical difference; a ranking correlation between E_dyn and E_sta is shown for the first time.     

Study of ultrasound stiffness imaging methods using tissue mimicking phantoms

A pilot study was carried out to investigate the performance of ultrasound stiffness imaging methods namely Ultrasound Elastography Imaging (UEI) and Acoustic Radiation Force Impulse (ARFI) Imaging. Specifically their potential for characterizing different classes of solid mass lesions was analyzed using agar based tissue mimicking phantoms. Composite tissue mimicking phantom was prepared with embedded inclusions of varying stiffness from 50 kPa to 450 kPa to represent different stages of cancer. Acoustic properties such as sound speed, attenuation coefficient and acoustic impedance were characterized by pulse echo ultrasound test at 5 MHz frequency and they are ranged from (1564 ± 88 to 1671 ± 124 m/s), (0.6915 ± 0.123 to 0.8268 ± 0.755 db cm^-1 MHz^-1) and (1.61×10⁶ ± 0.127 to 1.76 × 10⁶ ± 0.045 kg m^-2 s^-1) respectively. The elastic property Young’s Modulus of the prepared samples was measured by conducting quasi static uni axial compression test under a strain rate of 0.5 mm/min upto 10 % strain, and the values are from 50 kPa to 450 kPa for a variation of agar concentration from 1.7% to 6.6% by weight. The composite phantoms were imaged by Siemens Acuson S2000 (Siemens, Erlangen, Germany) machine using linear array transducer 9L4 at 8 MHz frequency; strain and displacement images were collected by UEI and ARFI. Shear wave velocity 4.43 ± 0.35 m/s was also measured for high modulus contrast (18 dB) inclusion and X.XX m/s was found for all other inclusions. The images were pre processed and parameters such as Contrast Transfer Efficiency and lateral image profile were computed and reported. The results indicate that both ARFI and UEI represent the abnormalities better than conventional US B mode imaging whereas UEI enhances the underlying modulus contrast into improved strain contrast. The results are corroborated with literature and also with clinical patient images.     

Noninvasive estimation of the ocular elastic modulus for age-related macular degeneration in the human eye using sequential ultrasound imaging

Introduction

Elastic modulus estimation may be an important clinical criterion, as it seems to affect such eye parameters as intraocular pressure, ocular pulsation, blood flow, effect of topical medications, and post-refractive surgery complications. The purpose of this study was to examine the differences in elasticity in the ocular axial length, posterior wall thickness (posterior pole), and retina-choroid thickness under normal and aged-related macular degeneration (AMD) conditions in the human eye by directly estimating the elastic modulus with sequential and noninvasive ultrasound image processing.

Materials and Methods

In this study, 25 healthy subjects and 20 patients with non-neovascular AMD participated in the experiment. The deformation of the ocular axial length, posterior wall thickness and retina-choroid complex thickness was captured using high-resolution ultrasonography before and after loading. The B-mode (20 MHz) and A-mode (8 MHz) frames were obtained and processed with an echo tracking technique. The elastic modulus was estimated using changes in ocular axial length, posterior wall thickness and retina-choroid complex thickness and with applied stress measurements.

Results

There was a significant difference (p < 0.05) in the ocular axial length elastic modulus between the AMD and healthy subjects (AMD patients: 95.165 ± 26.431 kPa, vs. healthy subjects: 49.539 ± 25.867 kPa). Moreover, there was a statistically significant difference (p < 0.05) in the posterior wall thickness elastic modulus between AMD patients and healthy subjects (AMD patients: 50.519 ± 12.295 kPa, vs. healthy subjects: 20.519 ± 11.827 kPa). However, no statistically significant difference (p-value > 0.05) was found in the retina-choroid complex elastic modulus between the two groups (AMD patients: 20.134 ± 3.898 kPa, vs. healthy subjects: 15.630 ± 4.250 kPa).

Conclusion

Although the results were obtained examining a relatively low number of patients, it would appear that noninvasive ultrasound estimation of the local elastic moduli of ocular axial length and posterior wall thickness is suited to aid in detection of the non-exudative AMD thus manifesting its potential as a screening tool in symptom-free individuals.     

Ultrasound frame rate requirements for cardiac elastography: experimental and in vivo results

Cardiac elastography using radiofrequency echo signals can provide improved 2D strain information compared to B-mode image data, provided data are acquired at sufficient frame rates. In this paper, we evaluate ultrasound frame rate requirements for unbiased and robust estimation of tissue displacements and strain. Both tissue-mimicking phantoms under cyclic compressions at rates that mimic the contractions of the heart and in vivo results are presented. Sinusoidal compressions were applied to the phantom at frequencies ranging from 0.5 to 3.5 cycles/sec, with a maximum deformation of 5% of the phantom height. Local displacements and strains were estimated using both a two-step one-dimensional and hybrid two-dimensional cross-correlation method. Accuracy and repeatability of local strains were assessed as a function of the ultrasound frame rate based on signal-to-noise ratio values.The maximum signal-to-noise ratio obtained in a uniformly elastic phantom is 20 dB for both a 1.26 Hz and a 2 Hz compression frequency when the radiofrequency echo acquisition is at least 12 Hz and 20 Hz respectively. However, for compression frequencies of 2.8 Hz and 4 Hz the maximum signal-to-noise ratio obtained is around 16 dB even for a 40 Hz frame rate. Our results indicate that unbiased estimation of displacements and strain require ultrasound frame rates greater than ten times the compression frequency, although a frame rate of about two times the compression frequency is sufficient to estimate the compression frequency imparted to the tissue-mimicking phantom. In vivo results derived from short-axis views of the heart acquired from normal human volunteers also demonstrate this frame rate requirement for elastography.     

2D myocardial strain assessment in the mouse: a comparison between a synthetic lateral phase approach and block-matching using computer simulation

Estimating myocardial strain in the mouse with clinical equipment remains difficult due to the high heart rate and the small size of the mouse heart. Measuring the strain component perpendicular to the ultrasound beam is especially challenging because of the lack of phase information in that direction and the large speckle width compared to the wall thickness. In this study, the performance of a Synthetic Lateral Phase (SLP) approach was contrasted to a standard and a regularized 2D Speckle Tracking (2D ST) algorithm using simulated data sets. SLP yielded higher rms errors for the lateral strain estimates than the regularized 2D ST (Lateral rms error: 0.087 ± 0.012 vs. 0.052 ± 0.010; p < 0.05). No significant difference was found between the standard 2D ST and SLP. For the axial strain estimates, SLP produced higher rms errors than the standard 2D ST (Axial rms error: 0.063 ± 0.012 vs. 0.040 ± 0.008; p < 0.05). 2D ST combined with geometric regularization showed thus to be the most accurate method.     

Relationships between the anisotropy of longitudinal wave velocity and hydroxyapatite crystallite orientation in bovine cortical bone

Quantitative ultrasound (QUS) is now widely used for evaluating bone in vivo, because obtained ultrasonic wave properties directly reflect the visco-elasticity. Bone tissue is composed of minerals like hydroxyapatite (HAp) and a collagen matrix. HAp crystallites orientation is thus one parameter of bone elasticity. In this study, we experimentally investigated the anisotropy of ultrasonic wave velocity and the HAp crystallites orientation in the axial-radial and axial-tangential planes in detail, using cylindrical specimens obtained from the cortical bone of three bovine femurs. Longitudinal bulk wave propagation was investigated by using a conventional ultrasonic pulse system. We used the one cycle of sinusoidal pulse which was emitted from wide band transmitter. The nominal frequency of the pulse was 1 MHz. First, we investigated the anisotropy of longitudinal wave velocity, measuring the anisotropy of velocity in two planes using cylindrical specimens obtained from identical bone areas. The wave velocity changed due to the rotation angle, showing the maximum value in the direction a little off the bone axis. Moreover, X-ray pole figure measurements also indicated that there were small tilts in the HAp crystallites orientation from the bone axis. The tilt angles were similar to those of the highest velocity direction. There were good correlations between velocity and HAp crystallites orientation obtained in different directions. However, a comparatively low correlation was found in posterior bone areas, which shows the stronger effects of bone microstructure. In the radial-tangential plane, where the HAp crystallites hardly ever align, weak anisotropy of velocity was found which seemed to depend on the bone microstructure.     

Relative contributions of porosity and mineralized matrix properties to the bulk axial ultrasonic wave velocity in human cortical bone

Velocity of ultrasound waves has proved to be a useful indicator of bone biomechanical competence. A detailed understanding of the dependence of ultrasound parameters such as velocity on bone characteristics is a key to the development of bone quantitative ultrasound (QUS). The objective of this study is to investigate the relative contributions of porosity and mineralized matrix properties to the bulk compressional wave velocity (BCV) along the long bone axis. Cross-sectional slabs from the diaphysis of four human femurs were included in the study. Seven regions of interest (ROIs) were selected in each slab. BCV was measured in through-transmission at 5 MHz. Impedance of the mineralized matrix (Z_m) and porosity (Por) were obtained from 50 MHz scanning acoustic microscopy. Por and Z_m had comparable effects on BCV along the bone axis (R = −0.57 and R = 0.72, respectively).     

Development of a portable 3D ultrasound imaging system for musculoskeletal tissues

3D ultrasound is a promising imaging modality for clinical diagnosis and treatment monitoring. Its cost is relatively low in comparison with CT and MRI, no intensive training and radiation protection is required for its operation, and its hardware is movable and can potentially be portable. In this study, we developed a portable freehand 3D ultrasound imaging system for the assessment of musculoskeletal body parts. A portable ultrasound scanner was used to obtain real-time B-mode ultrasound images of musculoskeletal tissues and an electromagnetic spatial sensor was fixed on the ultrasound probe to acquire the position and orientation of the images. The images were digitized with a video digitization device and displayed with its orientation and position synchronized in real-time with the data obtained by the spatial sensor. A program was developed for volume reconstruction, visualization, segmentation and measurement using Visual C++ and Visualization toolkits (VTK) software. A 2D Gaussian filter and a Median filter were implemented to improve the quality of the B-scan images collected by the portable ultrasound scanner. An improved distance-weighted grid-mapping algorithm was proposed for volume reconstruction. Temporal calibrations were conducted to correct the delay between the collections of images and spatial data. Spatial calibrations were performed using a cross-wire phantom. The system accuracy was validated by one cylinder and two cuboid phantoms made of silicone. The average errors for distance measurement in three orthogonal directions in comparison with micrometer measurement were 0.06 ± 0.39, −0.27 ± 0.27, and 0.33 ± 0.39 mm, respectively. The average error for volume measurement was −0.18% ± 5.44% for the three phantoms. The system has been successfully used to obtain the volume images of a fetus phantom, the fingers and forearms of human subjects. For a typical volume with 126 × 103 × 109 voxels, the 3D image could be reconstructed from 258 B-scans (640 × 480 pixels) within one minute using a portable PC with Pentium IV 2.4 GHz CPU and 512 MB memories. It is believed that such a portable volume imaging system will have many applications in the assessment of musculoskeletal tissues because of its easy accessibility.     

Excitation of ultrasonic Lamb waves using a phased array system with two array probes: Phantom and in vitro bone studies

Long bones are good waveguides to support the propagation of ultrasonic guided waves. The low-order guided waves have been consistently observed in quantitative ultrasound bone studies. Selective excitation of these low-order guided modes requires oblique incidence of the ultrasound beam using a transducer-wedge system. It is generally assumed that an angle of incidence, θ_i, generates a specific phase velocity of interest, c_o, via Snell’s law, θ_i = sin⁻¹(v_w/c_o) where v_w is the velocity of the coupling medium. In this study, we investigated the excitation of guided waves within a 6.3-mm thick brass plate and a 6.5-mm thick bovine bone plate using an ultrasound phased array system with two 0.75-mm-pitch array probes. Arranging five elements as a group, the first group of a 16-element probe was used as a transmitter and a 64-element probe was a receiver array. The beam was steered for six angles (0°, 20°, 30°, 40°, 50°, and 60°) with a 1.6-MHz source signal. An adjoint Radon transform algorithm mapped the time-offset matrix into the frequency-phase velocity dispersion panels. The imaged Lamb plate modes were identified by the theoretical dispersion curves. The results show that the 0° excitation generated many modes with no modal discrimination and the oblique beam excited a spectrum of phase velocities spread asymmetrically about c_o. The width of the excitation region decreased as the steering angle increased, rendering modal selectivity at large angles. The phenomena were well predicted by the excitation function of the source influence theory. The low-order modes were better imaged at steering angle ?30° for both plates. The study has also demonstrated the feasibility of using the two-probe phased array system for future in vivo study.     

Acoustic characterization of a new trisacryl contrast agent. Part II: Flow phantom study and in vivo quantification

The biocompatible trisacryl particles (TMP) are made of a cross-linked acrylic copolymer. Their inherent acoustic properties, studied for a contrast agent application, have been previously demonstrated in a in vitro Couette device. To measure their acoustic behaviour under circulating blood conditions, the TMP backscatter enhancement was further evaluated on a home-made flow phantom at different TMP doses (0.12-15.6 mg/ml) suspended in aqueous and blood media, and in nude mice (aorta and B16 grafted melanoma). Integrated backscatter (IB) was measured by spectral analysis of the Doppler signals recorded from an ultrasound system (Aplio^®) combined with a 12-MHz probe. Doppler phantom experiments revealed a maximal IB of 17 ± 0.88 dB and 7.5 ± 0.7 dB in aqueous and blood media, respectively. IB measured on mice aorta, in pulsed Doppler mode, confirmed a constant maximal value of 7.29 ± 1.72 dB over the first minutes after injection of a 7.8 mg/ml TMP suspension. Following the injection, a 60% enhancement of intratumoral vascularization detection was observed in power Doppler mode. A preliminary histological study revealed inert presence of some TMP in lungs 8 and 16 days after injection.Doppler phantom experiments on whole blood allowed to anticipate the in vivo acoustic behaviour. Both protocols demonstrated TMP effectiveness in significantly increasing Doppler signal intensity and intratumoral vascularization detection. However, it was also shown that blood conditions seemed to shadow the TMP contrast effect, as compared to in vitro observations. These results encourage further investigations on the specific TMP targeting and on their bio-distribution in the different tissues.     

Correlations between ultrasonic guided wave velocities and bone properties in bovine tibia in vitro

Correlations between ultrasonic guided wave velocities and bone properties were investigated in bovine tibia in vitro. The velocities of the first arriving signal and the slow guided wave, termed V(FAS) and V(SGW), along the long axis of the tibia were measured at 200 kHz in 20 bovine tibiae using the axial transmission technique. V(FAS) yielded significant negative correlation coefficients of -0.54 to -0.66 with the bone properties. In contrast, V(SGW) yielded strong positive correlation coefficients of 0.68-0.84. The best univariate predictor of V(FAS) and V(SGW) was the cortical thickness yielding adjusted squared correlation coefficients of 0.41 and 0.69, respectively.     

Monitoring tissue inflammation and responses to drug treatments in early stages of mice bone fracture using 50 MHz ultrasound

Bone fracture induces moderate inflammatory responses that are regulated by cyclooxygenase-2 (COX-2) or 5-lipoxygenase (5-LO) for initiating tissue repair and bone formation. Only a handful of non-invasive techniques focus on monitoring acute inflammation of injured bone currently exists. In the current study, we monitored in vivo inflammation levels during the initial 2 weeks of the inflammatory stage after mouse bone fracture utilizing 50 MHz ultrasound. The acquired ultrasonic images were correlated well with histological examinations. After the bone fracture in the tibia, dynamic changes in the soft tissue at the medial-posterior compartment near the fracture site were monitored by ultrasound on the days of 0, 2, 4, 7, and 14. The corresponding echogenicity increased on the 2nd, 4th, and 7th day, and subsequently declined to basal levels after the 14th day. An increase of cell death was identified by the positive staining of deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) assay and was consistent with ultrasound measurements. The increases of both COX-2 and Leukotriene B4 receptor 1 (BLT₁, 5-LO-relative receptor), which are regulators for tissue inflammation, in the immunohistochemistry staining revealed their involvement in bone fracture injury. Monitoring the inflammatory response to various non-steroidal anti-inflammatory drugs (NSAIDs) treatments was investigated by treating injured mice with a daily oral intake of aspirin (Asp), indomethacin (IND), and a selective COX-2 inhibitor (SC-236). The Asp treatment significantly reduced fracture-increased echogenicity (hyperechogenicity, p < 0.05) in ultrasound images as well as inhibited cell death, and expression of COX-2 and BLT₁. In contrast, treatment with IND or SC-236 did not reduce the hyperechogenicity, as confirmed by cell death (TUNEL) and expression levels of COX-2 or BLT₁. Taken together, the current study reports the feasibility of a non-invasive ultrasound method capable of monitoring post-fracture tissue inflammation that positively correlates with histological findings. Results of this study also suggest that this approach may be further applied to elucidate the underlying mechanisms of inflammatory processes and to develop therapeutic strategies for facilitating fracture healing.     

Optical probe using eccentric optics for optical coherence tomography

We propose and demonstrate an OCT optical probe using eccentric optics. This probe enabled both forward imaging and side imaging by dividing a circular scanning area into two semicircular scanning areas using an external motor to rotate the flexible tube. The outer diameter of the probe was 2.6 mm, and its rigid portion length was 10 mm. The lateral resolution was 23 μm, and the eccentric radius was 1.1 mm. The circumferential length in scanning was 6.9 mm, and the working distance was 5 mm. OCT images of 1.5 mm × 6.9 mm (in tissue, axial × circumference), including forward image and side image, were measured with the axial resolution of 19 μm in air and a frame rate of one frame per second. The epidermis, dermis, and sweat gland of in vivo human ventral finger tips were observed.     

Investigation of rat bone fracture healing using pulsed 1.5 MHz, 30 mW/cm burst ultrasound – Axial distance dependency

This study investigated the effect of LIPUS on fracture healing when fractures were exposed to ultrasound at three axial distances: z = 0 mm, 60 mm, and 130 mm. We applied LIPUS to rat fracture at these three axial distances mimicking the exposure condition of human fractures at different depths under the soft tissue. Measurement of LIPUS shows pressure variations in near field (nearby transducer); uniform profile was found beyond it (far field). We asked whether different positions of the fracture within the ultrasound field cause inconsistent biological effect during the healing process. Closed femoral fractured Sprague–Dawley rats were randomized into control, near-field (0 mm), mid-near field (60 mm) or far-field (130 mm) groups. Daily LIPUS treatment (plane, but apodized source, see details in the text; 2.2 cm in diameter; 1.5 MHz sine waves repeating at 1 kHz PRF; spatial average temporal average intensity, I_SATA = 30 mW/cm²) was given to fracture site at the three axial distances. Weekly radiographs and endpoint microCT, histomorphometry, and mechanical tests were performed. The results showed that the 130 mm group had the highest tissue mineral density; and significantly higher mechanical properties than control at week 4. The 60 mm and 0 mm groups had significantly higher (i.e. p < 0.05) woven bone percentage than control group in radiological, microCT and histomorphometry measurements. In general, LIPUS at far field augmented callus mineralization and mechanical properties; while near field and mid-near field enhanced woven bone formation. Our results indicated the therapeutic effect of LIPUS is dependent on the axial distance of the ultrasound beam. Therefore, the depth of fracture under the soft tissue affects the biological effect of LIPUS. Clinicians have to be aware of the fracture depth when LIPUS is applied transcutaneously.     

Using 1 MHz pulse-echo ultrasound externally applied to detect mastoid effusion: cadaver experiments

The objective of this study is to explore the feasibility of using ultrasound to detect mastoid effusion (ME). In the past, ultrasound has been used to measure middle ear effusion (MEE) by injecting water into the external ear canal to measure echoes from the tympanic membrane, which is uncomfortable for the patient. It has been shown that air cells in the mastoid of patients with MEE are filled with fluid, which implies that ME could be a useful indicator of MEE. This study suggests using ultrasound to detect ME as a potentially noninvasive approach for MEE detection. In vitro experiments were performed on ten cadaver samples of the human ear. A single-element 1 MHz transducer was used to measure the mastoid of each cadaver before and after injecting water into the mastoid. The experimental results showed that the relative amplitudes of ultrasonic signals differed significantly between before (0.24 ± 0.09, mean ± standard deviation) and after (0.15 ± 0.03) the water injection (p < 0.05, t-test), demonstrating that the ultrasonic reflection can be used to detect ME. The location of the human mastoid under the skin behind the ear allows external measurements, and hence ultrasound-based ME detection may be an alternative, noninvasive diagnostic approach to detecting MEE in the future, providing an examination that avoids discomfort.     

Noninvasive electromechanical wave imaging and conduction-relevant velocity estimation in vivo

Electromechanical wave imaging is a novel technique for the noninvasive mapping of conduction waves in the left ventricle through the combination of ECG gating, high frame rate ultrasound imaging and radio-frequency (RF)-based displacement estimation techniques. In this paper, we describe this new technique and characterize the origin and velocity of the wave under distinct pacing schemes. First, in vivo imaging (30 MHz) was performed on anesthetized, wild-type mice (n = 12) at high frame rates in order to take advantage of the transient electromechanical coupling occurring in the myocardium. The RF signal acquisition in a long-axis echocardiographic view was gated between consecutive R-wave peaks of the mouse electrocardiogram (ECG) and yielded an ultra-high RF frame rate of 8000 frames/s (fps). The ultrasound RF signals in each frame were digitized at 160 MHz. Axial, frame-to-frame displacements were estimated using 1D cross-correlation (window size of 240 μm, overlap of 90%). Three pacing protocols were sequentially applied in each mouse: (1) sinus rhythm (SR), (2) right-atrial (RA) pacing and (3) right-ventricular (RV) pacing. Pacing was performed using an eight-electrode catheter placed into the right side of the heart with the capability of pacing from any adjacent bipole. During a cardiac cycle, several waves were depicted on the electromechanical wave images that propagated transmurally and/or from base to apex, or apex to base, depending on the type of pacing and the cardiac phase. Through comparison between the ciné-loops and their corresponding ECG obtained at different pacing protocols, we were able to identify and separate the electrically induced, or contraction, waves from the hemodynamic (or, blood-wall coupling) waves. In all cases, the contraction wave was best observed along the posterior wall starting at the S-wave of the ECG, which occurs after Purkinje fiber, and during myocardial, activation. The contraction wave was identified based on the fact that it changed direction only when the pacing origin changed, i.e., it propagated from the apex to the base at SR and RA pacing and from base to apex at RV pacing. This reversal in the wave propagation direction was found to be consistent in all mice scanned and the wave velocity values fell within the previously reported conduction wave range with statistically significant differences between SR/RA pacing (0.85 ± 0.22 m/s and 0.84 ± 0.20 m/s, respectively) and RV pacing (−0.52 ± 0.31 m/s; p < 0.0001). This study thus shows that imaging the electromechanical function of the heart noninvasively is feasible. It may therefore constitute a unique noninvasive method for conduction wave mapping of the entire left ventricle. Such a technology can be extended to 3D mapping and/or used for early detection of dyssynchrony, arrhythmias, left-bundle branch block, or other conduction abnormalities as well as diagnosis and treatment thereof.     

Ultrasound biomicroscopy measurement of skin thickness change induced by cosmetic treatment with ultrasound stimulation

Moisturizing creams and lotions are commonly used in daily life for beauty and treatment of different skin conditions such as dryness and wrinkling, and ultrasound stimulation has been used to enhance the delivery of ingredients into skin. However, there is a lack of convenient methods to study the effect of ultrasound stimulation on lotion absorption by skin in vivo. Ultrasound biomicroscopy was adopted as a viable tool in this study to investigate the effectiveness of ultrasound stimulation on the enhancement of lotion delivery into skin. The forearm skin of 10 male and 10 female young subjects was tested at three different sites, including two lotion treatment sites with (Ultrasound Equipment – UE ON) and without (UE OFF) ultrasound stimulation and a control site without any lotion treatment. 1 MHz ultrasound with a duty cycle of 1.7%, a spatial peak temporal peak pressure of 195 kPa and an average power of 0.43 W was used for the stimulation. The skin thickness before, immediately after (0 min), and 15 and 30 min after the treatment was measured by an ultrasound biomicroscopic system (55 MHz). It was found that the skin thickness significantly increased immediately after the lotion treatment for both UE ON (from 1.379 ± 0.187 mm to 1.466 ± 0.182 mm, p < 0.001) and UE OFF (from 1.396 ± 0.193 mm to 1.430 ± 0.194 mm, p < 0.001) groups. Further comparison between the two groups revealed that the skin thickness increase of UE ON group was significantly larger than that of UE OFF group (6.5 ± 2.4% vs. 2.5 ± 1.3%, p < 0.001). Furthermore, it was disclosed that the enhancement of lotion delivery by ultrasound stimulation was more effective for the female subjects than the male subjects (7.6 ± 2.3% vs. 5.4 ± 2.0% immediately after treatment, p = 0.017). In conclusion, this study demonstrated that ultrasound biomicroscopy was a feasible method for studying the effectiveness of lotion treatment in vivo, and ultrasound stimulation was effective to enhance the rate of lotion absorption into skin.