| 1. |
- Caidahl, Kenneth, 1949, et al.
(författare)
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New concept in echocardiography: harmonic imaging of tissue without use of contrast agent.
- 1998
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Ingår i: Lancet (London, England). - : Elsevier BV. - 0140-6736. ; 352:9136, s. 1264-70
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Tidskriftsartikel (refereegranskat)abstract
- Endocardial border detection is important for echocardiographic assessment of left-ventricular function. Second harmonic imaging of contrast agents enhances this border detection. We discovered that harmonic imaging improves tissue visualisation even before contrast injection. We therefore sought objectively to demonstrate the degree of enhancement of endocardial and myocardial visualisation.An ATL HDI-3000 scanner with software for contrast harmonic imaging was used to record short-axis images of the left ventricle in 27 patients with possible myocardial disease and 22 controls, in the fundamental mode and with harmonic imaging. A computer program measured the relative grey-scale values within six segments of the endocardium and myocardium. An Acuson Sequoia scanner equipped with software for tissue harmonic imaging was used to investigate the reproducibility of ejection-fraction calculations in 22 patients with ischaemic heart disease.Harmonic imaging produced brighter endocardium within each segment. Relative to the mean grey value of the total imaging sector, the values for harmonic and fundamental imaging were 171.5 vs 85.6% (p<0.0001) in end diastole and 194.1 vs 106.7% (p<0.0001) in end systole. Results for the myocardial segments were also significantly better for harmonic imaging. Structure enhancement of similar magnitude was seen among patients and healthy controls. Use of harmonic imaging reduced the proportion of unacceptable images by 14-46% in different views and improved the reproducibility of biplane ejection-fraction measurements.In comparison with fundamental imaging, the relative endocardial and myocardial brightness is enhanced by harmonic imaging.
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| 2. |
- Holst, Karen, et al.
(författare)
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Projection-based respiratory-resolved left ventricular volume measurements in patients using free-breathing double golden-angle 3D radial acquisition.
- 2019
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Ingår i: Magma. - : Springer Science and Business Media LLC. - 1352-8661. ; 32:3
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Tidskriftsartikel (refereegranskat)abstract
- To refine a new technique to measure respiratory-resolved left ventricular end-diastolic volume (LVEDV) in mid-inspiration and mid-expiration using a respiratory self-gating technique and demonstrate clinical feasibility in patients.Ten consecutive patients were imaged at 1.5 T during 10 min of free breathing using a 3D golden-angle radial trajectory. Two respiratory self-gating signals were extracted and compared: from the k-space center of all acquired spokes, and from a superior-inferior projection spoke repeated every 64 ms. Data were binned into end-diastole and two respiratory phases of 15% respiratory cycle duration in mid-inspiration and mid-expiration. LVED volume and septal-lateral diameter were measured from manual segmentation of the endocardial border.Respiratory-induced variation in LVED size expressed as mid-inspiration relative to mid-expiration was, for volume, 1 ± 8% with k-space-based self-gating and 8 ± 2% with projection-based self-gating (P = 0.04), and for septal-lateral diameter, 2 ± 2% with k-space-based self-gating and 10 ± 1% with projection-based self-gating (P = 0.002).Measuring respiratory variation in LVED size was possible in clinical patients with projection-based respiratory self-gating, and the measured respiratory variation was consistent with previous studies on healthy volunteers. Projection-based self-gating detected a higher variation in LVED volume and diameter during respiration, compared to k-space-based self-gating.
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| 3. |
- Larsson, Malin, 1983-, et al.
(författare)
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A new ultrasound-based approach to visualize target specific polymeric contrast agent
- 2011
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Ingår i: 2011 IEEE International Ultrasonics Symposium (IUS). - : IEEE. - 9781457712524 ; , s. 1626-1629
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Konferensbidrag (refereegranskat)abstract
- There are advantages of using a polymeric shelled contrast agent (CA) during ultrasound imaging instead of lipid shelled CA, e.g. particles can be attached to the surface, which enables an introduction of antibodies to the surface making the CA target specific. For this application it is essential to have a sensitive imaging technique suitable for polymeric CA. However, previously presented results have indicated difficulties in visualizing polymeric CA with commercially available contrast algorithms. Therefore a new subtraction algorithm (SA), was developed that define the difference between contrast and reference images. The aim of this study was to evaluate the response from a polymeric CA, when using the SA and compare it with existing contrast algorithms. Moreover, the possibility to detect a thin layer of CA was tested using the SA.Ultrasound short-axis images of a tissue-mimicking vessel phantom with a pulsating flow were obtained using a GE Vivid7 system (M12L) and a Philips iE33 system (S5-1). Repeated (n=91) contrast to tissue ratios (CTR) calculated at various mechanical index (MI) using the contrast algorithms pulse inversion (PI), power modulation (PM) and SA at a concentration of 105microbubbles/ml.The developed SA showed improvements in CTR compared to existing contrast algorithms. The CTRs were -0.99 dB ± 0.67 (MI 0.2), 9.46 dB ± 0.77 (MI 0.4) and 2.98 dB ± 0.60 (MI 0.8) with PI, 8.17 dB ± 1.15 (MI 0.2), 15.60 dB ± 1.29 (MI0.4) and 11.60 dB ± 0.73 (MI 0.8) with PM and 14.97 dB ± 3.97 (MI 0.2), 20.89 dB ± 3.54 (MI 0.4) and 21.93 dB ± 4.37 (MI 0.8) with the SA. In addition to this, the layer detection, when using the SA was successful.
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| 4. |
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| 5. |
- Larsson, Malin K., et al.
(författare)
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Endocardial border delineation capability of a multimodal polymer-shelled contrast agent
- 2014
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundA novel polymer-shelled contrast agent (CA) with high mechanical and chemical stability was recently developed [1]. In excess to its ultrasound properties, it also supports targeted and multimodal imaging [2-4]. Even though these new possibilities have the potential to lead to new methodologies and approaches for non-invasive diagnosis, it is important that the fundamental diagnostic features in contrast-enhanced ultrasound are preserved. The aim of this study was therefore to examine the clinical use of the polymer-shelled CA by analyzing the left ventricular endocardial border delineation capability in a porcine model. In addition, physiological effects due to CA injections were studied.MethodsThe endocardial border delineation capability was assessed in a comparative study, which included three doses (1.5 ml, 3 ml and 5 ml, [5x108 MBs/ml]) of the polymer-shelled CA and the commercially available CA SonoVue® (1.5 ml, [2-5x108 MBs/ml]). Ultrasound images of the left ventricle were evaluated manually by blinded observers (n=3) according to a 6-segment model, in which each segment was graded as 0=not visible, 1=barely visible or 2=well visible, as well as semi-automatically by a segmentation software. Furthermore, duration of clinically useful contrast enhancement and changes in physiological parameters were evaluated.ResultsFor the highest dose of the polymer-shelled CA, the obtained segment scores, time for clinically sufficient contrast enhancement and semi-automatic delineation capability were comparable to SonoVue®. Moreover, neither dose of the polymer-shelled CA did affect the physiological parameters.ConclusionThis study demonstrated that the polymer-shelled CA can be used in contrast-enhanced diagnostic imaging without influence on major physiological parameters.
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| 6. |
- Larsson, Malin, 1983-
(författare)
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Toward increased applicability of ultrasound contrast agents
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ultrasound is one of the most widely used modalities in medical imaging because of its high cost-effectiveness, wide availability in hospitals, generation of real-time images, and use of nonionizing radiation. However, the image quality can be insufficient in some patients. Introducing a contrast agent (CA), which comprises a suspension of 2–6 mm-sized microbubbles, improves the image quality and thus the image analysis. At present, contrast-enhanced ultrasound is frequently used during standard clinical procedures such as kidney, liver, and cardiac (echocardiography) imaging. Multimodality and targeted imaging are future areas for ultrasound CAs. Multimodality imaging may improve diagnostics by simultaneously providing anatomical and functional information. Targeted imaging may allow for identification of particular diseases.The work within this thesis focused mainly on a novel multimodal polymer-shelled CA with the potential to be target specific. In Study I, the acoustic response was determined in a flow phantom by evaluating the contrast-to-tissue-ratio when using contrast sequences available in clinical ultrasound systems. This study showed that a high acoustic pressure is needed for optimal visualization of the polymer-shelled CA. In Study II, the in vivo performance of this CA was evaluated in a rat model, and the blood elimination time and subcellular distribution were determined. In Study III, the efficiency in endocardial border delineation was assessed in a pig model. The polymer-shelled CA had a significantly longer blood circulation time than the commercially available CA SonoVue, which is favorable for target-specific CA, in which a long circulation time increases the probability of target-specific binding. Transmission electron microscopic analysis of tissue sections from liver, kidney, spleen and lungs, obtained at different time points after CA injection showed that macrophages were responsible for the elimination of the polymer-shelled CA. A higher dose of the polymer-shelled CA was needed to obtain similar endocardial border delineation efficiency as that obtained using SonoVue. The results of Studies I–III demonstrate that the polymer-shelled CA has potential applicability in medical imaging.Current guidelines for contrast-enhanced echocardiography are limited to cases of suboptimal image quality or when there is a suspicion of structural abnormalities within the left ventricle. It may be hypothesized that the wider use of contrast-enhanced echocardiography may help to detect some diseases earlier. Study IV assessed the diagnostic outcomes after contrast administration in patients without indications for CA use. The myocardial wall motion score index and ejection fraction were evaluated by experienced and inexperienced readers, and a screening for left ventricular structural abnormalities was performed. More cases of wall motion and structural abnormalities were detected in the contrast-enhanced analysis. Intra- and interobserver variability was lower with the use of CAs. This study suggests that the more widespread use of CAs instead of the current selective approach may contribute to earlier detection of cardiovascular disease.
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| 7. |
- Röhl, Samuel, et al.
(författare)
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Noninvasive in vivo Assessment of the Re-endothelialization Process Using Ultrasound Biomicroscopy in the Rat Carotid Artery Balloon Injury Model.
- 2019
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Ingår i: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. - : Wiley. - 1550-9613. ; 38:7, s. 1723-1731
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Tidskriftsartikel (refereegranskat)abstract
- Ultrasound biomicroscopy (UBM), or ultra high-frequency ultrasound, is a technique used to assess the anatomy of small research animals. In this study, UBM was used to assess differences in intimal hyperplasia thickness as a surrogate measurement of the re-endothelialization process after carotid artery balloon injury in rats.Ultrasound biomicroscopic data from 3 different experiments and rat strains (Sprague Dawley, Wistar, and diabetic Goto-Kakizaki) were analyzed. All animals were subjected to carotid artery balloon injury and examined with UBM (30-70 MHz) 2 and 4 weeks after injury. Re-endothelialization on UBM was defined as the length from the carotid bifurcation to the most distal visible edge of the intimal hyperplasia. En face staining with Evans blue dye was performed at euthanasia 4 weeks after injury, followed by tissue harvesting for histochemical and immunohistochemical evaluations.A significant correlation (Spearman r = 0.63; P < .0001) was identified when comparing all measurements of re-endothelialization obtained from UBM and en face staining. The findings revealed a similar pattern for all rat strains: Sprague Dawley (Spearman r = 0.70; P < .0001), Wistar (Spearman r = 0.36; P < .081), and Goto-Kakizaki (Spearman r = 0.70; P < .05). A Bland-Altman test showed agreement between en face staining and UBM. Immunohistochemical staining confirmed the presence of the endothelium in the areas detected as re-endothelialized by the UBM assessment.Ultrasound biomicroscopy can be used for repeated in vivo assessment of re-endothelialization after carotid artery balloon injury in rats.
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| 8. |
- Widman, Erik, 1981-, et al.
(författare)
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SHEAR WAVE ELASTOGRAPHY OF THE ARTERIAL WALL – WHERE WE ARE TODAY
- 2013
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Konferensbidrag (refereegranskat)abstract
- 1. IntroductionShear Wave Elastography (SWE) is a recently developed noninvasive method for elastography assessment using ultrasound. The technique consists of sending an acoustic radiation force (pushing sequence) into the tissue that in turn generates an orthogonal low frequency propagating shear wave. The shear wave propagation is measured real time by high speed B-mode imaging. From the B-mode images, the shear wave is tracked via normalized cross-correlation and the speed is calculated, which is used to generate an elasticity map of the tissue’s shear modulus. To date, the technique has mostly been used in large homogeneous tissues such as breast and liver where it successfully detects lesions and tumors that are easily missed with normal B-mode ultrasound [1]. SWE could potentially be applied in vascular applications to assess elasticity of the arterial wall to characterize the stiffness as an early indicator of cardiac disease. Furthermore, SWE could aid in the characterization of plaques in the carotid artery, which is critical for the prevention of ischemic stroke2. Methods and ResultsAn initial study was performed using an Aixplorer SWE system (Supersonic Imagine, France) to measure the shear modulus in a polyvinyl alcohol phantom (PVA) vessel with a plaque inclusion (Figure 1). It was possible to distinguish the softer inclusion mean shear wave speed (2.1 m/s) from the arterial wall (3.5 m/s) on the SWE colour-map, but the Young’s Modulus calculation of the arterial wall (E=19.8 kPa) did not match the measured Young’s Modulus (E=53.1 kPa) from comparative mechanical testing.We have begun implementing various pushing sequences (single unfocused push, single focused push, line push, comb push) on a programmable ultrasound machine (Verasonics, USA) using a linear transducer (Philips L7-4) in a homogeneous PVA phantom. An algorithm for one dimensional cross-correlation tracking and shear wave speed estimation has been developed and initially tested in an experimental setup3. DiscussionAccording to our initial results, it is possible that SWE could be applied in vascular applications. However, the initial mechanical testing vs. SWE comparison indicated that further development to the post processing is needed before applying it on the carotid artery, which is a heterogeneous tissue with other wave propagation properties than e.g. breast tissue. The carotid artery has a difficult geometry to study for several reasons. The intima-media complex is very thin (< 1mm), and the vessel wall is not stationary. Furthermore, the cylindrical shape of the artery produces complex wave reflections within the arterial wall, which result in a polychromatic propagation of the shear wave. A few studies have applied techniques based on SWE to the arterial wall with promising results and a pilot study demonstrating the feasibility of the technique in-vivo has been published [2]. Still, a considerable effort is needed to validate and optimize the technique for the clinical vascular setting.
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| 9. |
- Widman, Erik, 1981-, et al.
(författare)
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Shear Wave Elastography Quantifies Stiffness in Ex Vivo Porcine Artery with Stiffened Arterial Region
- 2016
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Ingår i: Ultrasound in Medicine and Biology. - : Elsevier. - 0301-5629 .- 1879-291X. ; 42:10, s. 2423-2435
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Tidskriftsartikel (refereegranskat)abstract
- Five small porcine aortas were used as a human carotid artery model, and their stiffness was estimatedusing shear wave elastography (SWE) in the arterial wall and a stiffened artery region mimicking a stiff plaque. Tooptimize the SWE settings, shear wave bandwidth was measured with respect to acoustic radiation force pushlength and number of compounded angles used for motion detection with plane wave imaging. The mean arterialwall and simulated plaque shear moduli varied from 41 ± 5 to 97 ± 10 kPa and from 86 ± 13 to 174 ± 35 kPa, respectively,over the pressure range 20–120 mmHg. The results revealed that a minimum bandwidth of approximately1500 Hz is necessary for consistent shear modulus estimates, and a high pulse repetition frequency using no imagecompounding is more important than a lower pulse repetition frequency with better image quality when estimatingarterial wall and plaque stiffness using SWE.
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| 10. |
- Widman, Erik, 1981-, et al.
(författare)
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Speckle tracking strain estimation of a carotid artery plaque phantom - Validation via sonomicrometry
- 2013
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Ingår i: 2013 IEEE International Ultrasonics Symposium (IUS). - : IEEE conference proceedings. - 9781467356848 ; , s. 1757-1760
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Konferensbidrag (refereegranskat)abstract
- Current clinical ultrasound-based methods for plaque characterization are limited to visual assessment of plaque echogenicity creating demand for quantitative diagnostic tools. Our objective was to validate radial and longitudinal speckle tracking (ST) strain in phantom plaques via sonomicrometry (sono), and to compare the peak plaque and arterial wall strain. Four carotid artery gel-phantoms with a soft wall inclusion, mimicking a vulnerable plaque, were constructed. The phantoms were connected to a programmable pump simulating a carotid flow. Cineloops were acquired using a GE Vivid E9 where radial and longitudinal strain were calculated using a normalized cross-correlation ST algorithm. The region of interest was adjusted according to the plaque size. Sonomicrometry was used as a reference measurement. The correlation between estimated mean peak strain and the reference peak strain was r = 0.96 (p < 0.001) radially and r = 0.75 (p ≤ 0.005) longitudinally. The soft plaque exhibited 35.1% (SD 16.9%) greater radial (p < 0.001) and 88.6% (SD 72.0%) greater longitudinal (p < 0.001) peak strain than the arterial wall when measured with speckle tracking. It was possible to estimate plaque strain by ST and to distinguish a soft plaque from the vessel wall via strain measurements.
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