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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013SPECIAL INTEREST SESSIONSMONDAY, APRIL 8, 2013, 1:30 PM–3:30 PMCellular Bioeffects and ApplicationsModerator: Diane Dalecki, PhDApplications of Ultrasound Standing Wave Fields in Tissue EngineeringDiane Dalecki University of Rochester, Rochester, New YorkUSAThe field of tissue engineering aims to develop technologiesthat enable the repair or replacement of diseased or injured tissues and organs.The spatial organization of cells within native and engineered tissuesis essential for proper tissue assembly and organ function. Thus, successfulengineering of complex tissues and organs requires methods to controlcell organization in 3 dimensions. Acoustic radiation forces associatedwith ultrasound standing wave fields provide a rapid, noninvasive approachto spatially pattern cells in 3 dimensions without affecting cell viability.Results of several investigations will be presented that demonstratethe use of ultrasound standing wave fields to pattern cells or protein-boundmicroparticles in 3D hydrogels. Furthermore, patterning of endothelialcells with ultrasound standing wave fields leads to rapid and extensivevessel network formation in 3D collagen-based constructs. Thus, ultrasoundstanding wave fields provide new strategies to pattern cells and directvascular network formation and morphology within engineered tissueconstructs.Interactions of Microbubbles With Cells and Their Applications forDrug and Gene DeliveryCheri Deng University of Michigan, Ann Arbor, MichiganUSASonoporation uses ultrasound application to generate microbubbleactivities to transiently disrupt the cell membrane for enhancingintracellular transport of exogenous agents for drug and gene deliveryapplications. However, success of sonoporation is hindered by low deliveryefficiencies and variable outcomes. These difficulties are due to thelack of understanding of the detailed processes supporting ultrasound-inducedtransport into and within the cytoplasm of living cells. The dynamicmicrobubble activities driven by ultrasound application induce cellularbioeffects that can determine the delivery outcome, including delivery efficiencyand cell viability. In this presentation, we provide an examinationof these biophysical and biochemical effects resulting from interactionof ultrasound-driven microbubbles with cells and whether they play importantroles in the sonoporation outcome. We developed novel techniquesto control and investigate ultrasound-driven microbubble cavitation in referenceto single cells and the resulting membrane disruptions. We used simultaneouswhole-cell patch clamp recording and fluorescence microscopyto characterize the formation and resealing of ultrasound-induced membranepores. We demonstrated spatiotemporally controlled subcellular deliveryand calcium signaling in targeted cells. In addition, based on theultrasound-driven microbubble activities, we implemented an ultrasoundexposure strategy to improve gene transfection. These results may providerelevant information for further development of sonoporation.Directing Extracellular Matrix Protein Microstructure With UltrasoundDenise Hocking Pharmacology and Physiology, Universityof Rochester, Rochester, New York USAThe extracellular matrix is a complex network of interconnectedproteins and polysaccharides that provides structure to tissues and instructscell behaviors. The microstructure and molecular conformation of extracellularmatrix proteins provide signals that direct cell functions critical totissue formation and regeneration, including proliferation, migration, andmatrix remodeling. Thus, controlling extracellular matrix protein structureprovides a means to regulate the mechanical properties of biomaterialsand control cellular responses. Moreover, biomaterials with regionallydefined extracellular matrix structure could provide local cues to instructcell behavior and drive proper tissue function in 3 dimensions. Collagenis the primary fibrous component of the extracellular matrix. The tremendousdiversity of the functional properties of type I collagen arises fromvariations in the micromolecular and macromolecular structure of polymerizedcollagen fibers. Results of our studies demonstrate the capabilityof ultrasound to spatially pattern various collagen microstructures withinan engineered tissue noninvasively, thus enhancing the level of complexityof extracellular matrix microenvironments and cellular functionsachievable within 3D engineered tissues.Elastography 2013Moderator: Richard Barr, MD, PhDElastography of Diffuse Liver DiseaseGiovanna Ferraioli,* Carlo Filice Infectious Diseases, FondazioneIstituto di Ricovero e Cura a Carattere Scientifico,Policlinico San Matteo, Medical School, University of Pavia,Pavia, ItalyThe prognosis and management of patients with chronic liverdiseases largely depend on the extent and progression of liver fibrosis.Liver biopsy is still considered the reference standard for assessing liverfibrosis. It is an invasive procedure that carries a risk of complications.Moreover, it is not an ideal method for repeated evaluation of disease progression.For these reasons, techniques that noninvasively assess liver fibrosishave been developed. Elastography is a technique that analyzes themechanical and elastic properties of soft tissue that could be modified bypathologic conditions. Real-time elastography, which allows measurementof tissue’s stiffness while guided by the B-mode image, is either strainbased or shear wave based. With strain-based elastography, the displacementof tissues due to an applied stress is detected. With all the shear wavebasedtechniques, there is a generation of shear waves determined bytissue’s displacement induced by the force of a focused ultrasound beam.Real-time elastographic methods are included in standard ultrasound systems.Based on our experience and that of other groups, we believe thatshear wave–based methods are ready to be used in patients with chronichepatitis C to assess liver fibrosis before therapy at a safe level of predictability.S31
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Exploring the Interface of Ethics and Communicationin Prenatal Care: A Video-Based ApproachModerator: Stephen Brown, MDExploring the Interface of Ethics and Communication in PrenatalCounseling: A Video-Based ApproachStephen Brown, 1 * Bryann Bromley, 3,4,5 Elaine Meyer 2,61Radiology, 2 Institute for Professionalism and Ethical Practice,Boston Children’s Hospital, Boston, Massachusetts USA;3Diagnostic Ultrasound Associates, Boston, MassachusettsUSA; 4 Obstetrics and Gynecology, Massachusetts GeneralHospital and Brigham and Women’s Hospital, Boston, MassachusettsUSA; 5 Radiology, Brigham and Women’s Hospital,Boston, Massachusetts USA; 6 Psychiatry, Harvard MedicalSchool, Boston, Massachusetts USACourse objectives: (1) Evaluate strategies to communicate effectivelywhen conveying difficult information to patients. (2) Explorehow micro-ethical issues are embedded in patient-clinician communication.(3) Examine the clinical and ethical dimensions of prenatal counselingfrom the perspectives of upstream and downstream clinical providers.Course description: In this interactive workshop, faculty and audience willview and discuss videotaped counseling sessions between experiencedclinicians and trained actors portraying expectant parents after diagnosesof miscarriage in the first trimester and spina bifida in the second trimester.When such conditions are diagnosed, practitioners who counsel patientsmust convey cognitively and ethically complex information under emotionallycharged circumstances. Few educational opportunities exist tohelp practitioners acquire the skills necessary to approach these conversationseffectively. Such skills are essential for obstetric and pediatric specialistswho engage in prenatal diagnosis and counseling. In this workshop,participants will collectively explore and share their perspectives regarding:(1) the “art” of difficult communication; (2) how values may influencedecision making; (3) how language usage, framing of choices, provisionof information, and offers of resources may confound neutrality; (4) potentialdifferences in attitudes and counseling practices between practitionersfrom different disciplines; and (5) strategies to teach this difficultcommunication process. Workshop faculty includes a pediatric and obstetricimaging specialist and bioethicist, a maternal-fetal medicine andobstetric imaging specialist, and a psychologist and pediatric critical carenursing specialist who is an expert in health care communication.Hands-on Carotid and Transcranial DopplerUltrasoundModerator: Tatjana Rundek, MDIn this session, participants will be provided with live demonstrationsof carotid and transcranial Doppler scanning protocols and handsonpractice sessions at ultrasound stations.New Techniques and Methods in Ultrasound-GuidedInterventionsModerator: Corinne Deurdulian, MDUtilization of Contrast-Enhanced Ultrasound in InterventionalRadiologyDean Huang Clinical Radiology, King’s College Hospital,London, EnglandS32The aim of this talk is to consider the applications of contrast-enhancedultrasound (CEUS) in interventional radiology. One of the most establishedtechniques in imaging-guided, minimally invasive procedures iswith ultrasound, a tool that is safe, mobile, and cost-effective. CEUS providesbetter images than conventional B-mode images, improves the abilityto differentiate between normal and abnormal tissue, and simplifies the precisenavigation of needles during an intervention. CEUS therefore could playan important role in procedure planning, needle navigation, and postprocedurefollow-up imaging, particularly when iodinated contrast or ionizing radiationis undesirable or in unstable patients where “bedside” procedures areadvantageous. A number of interventional procedures in which CEUS hasbeen integrated into the management, both in nonvascular and vascular intervention,are illustrated. Examples of nonvascular applications include urologicintervention with CEUS-guided nephrostomy and CEUS-guidednephrostography, CEUS-guided percutaneous biopsy and abscess drainage,CEUS-guided transhepatic T-tube cholangiography, and CEUS-guided oncologicintervention in thermal ablation of hepatic and renal tumors. Examplesof vascular intervention with CEUS include management of endoleaksfollowing endovascular aortic stent graft repair, pseudoaneurysms followingarterial injury with CEUS-guided percutaneous thrombin injection, andCEUS-guided dialysis arteriovenous fistula angioplasty. Through a casebasedapproach, this talk aims to demonstrate that CEUS not only can be utilizedsafely and effectively in radiologic intervention but may also providenovel, tailor-made solutions to complex clinical problems.Vaginal Bleeding in the First TrimesterModerator: Leslie Scoutt, MDUltrasound Evaluation for Retained Products of ConceptionDouglas Brown Radiology, Mayo Clinic, Rochester,Minnesota USAIn this session, we will review sonographic features for identifyingretained products of conception in patients with spontaneous miscarriageand after surgical intervention. Limitations of ultrasound for thispurpose will be reviewed. Miscellaneous abnormalities occurring inwomen after spontaneous miscarriage will also be reviewed, including subinvolutionof the placental bed, which can present a diagnostic dilemma.Diagnostic Criteria for Miscarriage and Nonviable Pregnancy in theEarly First TrimesterPeter Doubilet Radiology, Brigham and Women’s Hospital,Boston, Massachusetts USA; Radiology, Harvard MedicalSchool, Boston, Massachusetts USAWhen a woman presents with symptoms of pain or bleeding inearly pregnancy, the main diagnostic possibilities are currently viable intrauterinepregnancy, failed (or failing) intrauterine pregnancy, and ectopicpregnancy. Serum human chorionic gonadotropin (hCG) measurementand pelvic ultrasound are commonly performed to aid in the differentialdiagnosis. At that point, unless an emergently life-threatening situationdictates management, a key question is: “Is there a chance of a viable pregnancy?”.This question is central to management decision making in 2main clinical settings: intrauterine pregnancy of uncertain viability andpregnancy of unknown location. Research over the past 2 to 3 years hascalled into question previously accepted dogma regarding criteria for rulingout the possibility of a viable pregnancy, which had been based onsmall study populations. We will consider 3 scenarios: (1) Ultrasounddemonstrates an intrauterine gestational sac, with or without a visible embryo,with no cardiac activity: What are the criteria for definitive diagnosisof failed pregnancy (“miscarriage”)? (2) Ultrasound demonstrates asmall saclike structure in the uterus, without a visible yolk sac or embryo:Is it a gestational sac or pseudogestational sac? (3) Ultrasound demonstratesno intrauterine fluid collection and no adnexal mass suspicious forectopic pregnancy: What is the significance if the hCG value is above the“discriminatory level” or if it is below the “discriminatory level”?
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