Elastographic US and G I GIST Tumor

Supersonic to debut quantification tools at RSNA 2019.

By AuntMinnie.com staff writers

November 26, 2019 -- Ultrasound equipment manufacturer SuperSonic Imagine will be debuting three new quantitative liver ultrasound applications at the upcoming RSNA 2019 meeting in Chicago.

The first two tools, Att Plus and SSp Plus, are designed to simultaneously quantify ultrasound attenuation in the liver and intrahepatic speed of sound to reflect fat content for detecting and diagnosing hepatic steatosis, according to the vendor.

The third new tool, Vi Plus, works in combination with real-time elasticity imaging to visualize and quantify tissue viscosity. These viscosity assessments provide clinicians with information for tissue characterization.

Liver Health: Three New Ultrasound Markers Enter the U.S. Market

SuperSonic Imagine, a major actor promoting innovation in ultrasound, will introduce a suite of three ultrasound markers for non-invasive assessment of the severity of chronic liver diseases with quantitative results: Att PLUS, SSp PLUS and Vi PLUS. The first two of these tools allow for the simultaneous quantification of ultrasound attenuation in the liver and intrahepatic sound speed, reflecting fat content, an essential criterion for the detection and diagnosis of hepatic steatosis. Coupled with elasticity imaging in real time, the third one, Vi PLUS, makes it possible to visualise and quantify tissue viscosity, providing clinicians with important information for tissue characterisation.

“Liver diseases including non-alcoholic steatohepatitis (NASH) linked to conditions like diabetes and obesity affect millions of Americans and have become an important public health concern in the space of just a few years. We are very proud to present the fruits of our expertise in liver health — the series of three non-invasive liver markers — for the first time in the United States. All the more so as these markers have just received 510(k) clearance from the FDA. Following the acquisition of SuperSonic Imagine by Hologic, we are also going to present many shared sessions dedicated to women's health,” concludes Michèle Lesieur, the CEO of SuperSonic Imagine.

ULTRASOUND THALAMOTOMY MAY HELP TREAT ESSENTIAL TREMOR.

By AuntMinnie.com staff writers

November 21, 2019 -- A treatment that uses ultrasound may be effective in relieving symptoms of essential tremor by targeting the affected area of the brain, according to a study published online November 20 in Neurology. The treatment, called focused ultrasound thalamotomy, essentially destroys the area of the brain causing the tremor.

More than 7 million people in the U.S. have essential tremor, according to the American Academy of Neurology. Currently, the most common treatment for the disorder when patients don't respond to medication is deep brain stimulation, a procedure that involves incisions and insertion of electrodes or probes into the patient's brain. Ultrasound thalamotomy would offer a less invasive treatment option and remains effective for approximately three years. It does, however, cause an irreversible brain lesion.

For the study, 56 patients received ultrasound thalamotomy and 20 received a fake treatment. The research team measured hand tremors, level of disability, and quality of life at the commencement of the study and after six months, one year, two years, and three years. By the three-year mark, the researchers noted a 50% improvement in hand tremors, a 56% improvement in disability, and a 42% improvement in quality of life.

While senior author Dr. Casey Halpern of Stanford University did note some limitations of the study, he concluded that "this treatment should be considered as a safe and effective option" for those living with essential tremor.

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Ultrasensitive Ultrasound Microvessel Imaging (UMI) boots BI-RADS accuracy

New breast ultrasound technique boosts BI-RADS accuracy

By Kate Madden Yee, AuntMinnie.com staff writerUsing a novel ultrasound technique called ultrasensitive ultrasound microvessel imaging (UMI) with conventional ultrasound significantly improves the diagnostic accuracy of BI-RADS classification of breast lesions, according to a study to be published in the December issue of Ultrasound in Medicine and Biology.

And improved BI-RADS categorization could translate into fewer unnecessary breast biopsies, wrote a team led by Ping Gong, PhD, of the Mayo Clinic in Rochester, MN.

"The microvessel information provided by ultrasound microvessel imaging may add clinical value to supplemental ultrasound screening adjunct to mammography in reducing unnecessary and missed biopsies," the researchers wrote.

Reducing false positives

Combining ultrasound with mammography improves diagnostic sensitivity in women with dense tissue compared with mammography alone, Gong and colleagues noted. But the combination can also increase false positives due to the low specificity of ultrasound -- leading to more unnecessary biopsies. That's why improving ultrasound's performance is important (Ultrasound Med Biol, December 2019, Vol. 45:12, pp. 3128-3136).

"In contrast to normal tissue and benign tumors, malignant tumors typically present a vessel pattern with chaotic distribution, irregular branches, and penetrating peripheral vasculature," the group wrote. "[But] the clinical reliability of conventional Doppler is undermined by limited vessel detection sensitivity. An ultrasensitive ultrasound microvessel imaging technique ... [provides] advanced vessel sensitivity ... without using ultrasound contrast agents."

Instead of the line-by-line scanning of conventional Doppler ultrasound, UMI is based on "ultrafast plane wave imaging ... that leads to at least 10 times more ultrasound frames for blood flow detection than conventional Doppler," the group wrote. This rapid imaging allows for a much higher sensitivity for visualizing microvessels, which helps distinguish between malignant and benign lesions, study co-author Shigao Chen, PhD, also of the Mayo Clinic, told AuntMinnie.com via email.

"Conventional ultrasound has low sensitivity for detecting very small vessels, and thus may miss the microvessels in the tumor which provide important information for diagnosis," he said. "This technology uses a newer ultrasound scanner with very high imaging frame rates so that more data can be acquired to boost sensitivity, and it uses more advanced signal processing to better remove tissue signal -- which is orders of magnitudes higher than blood signal -- to reveal the underlying microvessels," he said.

The researchers sought to explore the feasibility of UMI for assessing breast tumor microvessel distribution and to compare the performance of UMI and conventional ultrasound in differentiating between benign and malignant lesions. The study included 44 women with 51 breast masses, all of whom were imaged with conventional ultrasound and the combination of conventional ultrasound and UMI. Of the 51 masses, 28 were malignant and 23 were benign.

Gong's group found that adding UMI to conventional ultrasound significantly improved the visualization of small vessels compared with Doppler ultrasound alone across a variety of performance measures and that the microvessel structures UMI depicted were associated with benign or malignant tumor characteristics.

Performance of conventional ultrasound alone compared with ultrasound plus UMI
Performance measure	Conventional ultrasound	Ultrasound plus UMI
Sensitivity	96.4%	100%
Specificity	17.4%	47.8%
Positive predictive value	58.7%	70%
Negative predictive value	80%	100%
Diagnostic accuracy	60.8%	76.5%

The study also found that the diagnostic accuracy of correct BI-RADS categories improved by 16 percentage points with the combination of conventional ultrasound and UMI compared with ultrasound alone.

"This improvement indicates the potential of UMI in reducing unnecessary benign biopsies and avoiding missed malignant biopsies," Gong and colleagues wrote.

Keep the research coming

More research using this ultrasound technique is needed, Chen told AuntMinnie.com.

"If this preliminary research is confirmed by larger studies, it will imply that information about the microvasculature of the tumor obtained by ultrasensitive Doppler ultrasound can be used to differentiate benign from malignant tumors and thus reduce unnecessary biopsy," he said. "In addition, the technology may be useful for early evaluation of treatment effects to guide adjustment of chemotherapy or medical therapy regimens and avoid unnecessary side effects of ineffective therapies."

PocUS a Septic SHOCK Case

Abstract

A 77-year old male was admitted in the emergency department for septic shock, yet no clear source of infection was noted upon physical examination and a portable chest x-ray. 

Due to his unstable condition, bedside ultrasound was performed. A heterogeneous mass in the liver was noted, hence a tentative diagnosis of liver abscess was made. This was latter confirmed by abdominal computed tomography. 

This case highlights that point-of-care ultrasound, when performed by expert physicians, can significantly decrease time to diagnosis for septic patients.

O-RADS US