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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Ectopic PregnancyJames Shwayder Obstetrics and Gynecology, University ofMississippi Medical Center, Jackson, Mississippi USAThis portion of the session will address new nomenclature relatedto ectopic pregnancies and pregnancies of unknown location. It willdiscuss the relative merit of various laboratory and ultrasound findings indiagnosing ectopic pregnancies, presented with clinical correlation.SPECIAL INTEREST SESSIONSMONDAY, APRIL 8, 2013, 4:00 PM–5:30 PMHands-on ElastographyModerator: Richard Barr, MD, PhDThis session is designed to provide a workshop with variousvendors demonstrating how to perform and interpret elastography withtheir equipment and demonstrating the differences in techniques betweenvendors to obtain optimal images.Interventional and Other Ultrasound Techniques:How I Do ItModerator: David Fessell, MDAfter attending this session, participants will know when andhow to use interventional musculoskeletal ultrasound techniques.Quantitative Ultrasound BiomarkersModerators: Paul Carson, PhD, Timothy Hall, PhD, ABRQuantitative Ultrasound Applied to Detection and Imaging ofProstate Cancer and Lymph Node MetastasesErnest Feleppa Frederic L. Lizzi Center for BiomedicalEngineering, Riverside Research, New York, New York USAUltrasound is a popular clinical-imaging modality for displayingthe macroscopic anatomy of soft tissue structures in medical andresearch applications. While conventional ultrasound methods (eg, B-mode, harmonic, and Doppler methods) are well established and continueto advance technically, quantitative ultrasound (QUS) technologiesalso are emerging that appear to offer exciting promise for significantlyimproving clinical imaging of disease. These emerging methods includespectrum analysis, envelope statistics analysis, strain and Young’s modulusestimation, contrast-based perfusion kinetics, and advanced flowdetection and measurement techniques. Each QUS method provides independentinformation, and each offers powerful quantitative tissue-typingand imaging capabilities. However, a multifeature approach thatcombines estimates derived from different QUS methods may provideeven more powerful capabilities, eg, by combining spectrum analysisand envelope statistic parameters. This presentation will review progressspecifically in QUS applied to tissue-type imaging of prostate cancerand detection of lymph node metastases. Prostate cancer cannot be reliablyimaged by conventional ultrasound, and small, but clinically significant,lymph node metastases easily can be overlooked by currenthistopathologic methods. The QUS methods of particular interest inthese applications are spectrum analysis and envelope statistics. QUSapplied to detection of prostate cancer produces an area under the receiveroperating characteristic curve of 0.84, while QUS applied to detectionof lymph node colorectal and gastric cancer metastases producesan area exceeding 0.95; both results are markedly superior to the performanceof current methods. The implications for prostate cancer managementare improved biopsies, noninvasive disease monitoring, andaccurate focal treatment targeting; the implications for lymph nodehistopathology are improved detection of metastases and more accuratecancer staging.Ultrasound IncidentalomasModerator: Franklin Tessler, MD, CMIncidental Findings in the Soft Tissue and ExtremitiesDeborah Rubens Imaging Science, University of Rochester,Rochester, New York USAThis session will cover incidental findings discovered duringexamination of the soft tissues and extremities. Topics will include solidmasses, fluid collections, and vascular findings that are unexpected and notpart of the original diagnostic question. Management and reporting issueswill be addressed: which findings require immediate phone calls, whichcan be mentioned in the report but are not urgent, and which can be ignoredaltogether.S33
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013SCIENTIFIC SESSIONSMONDAY, APRIL 8, 2013, 4:00 PM–5:30 PMCarotid/Cerebrovascular Ultrasound andNeurosonologyModerator: David Vilkomerson, PhD1538396 Monitoring the Formation of Aneurysms in Murine AortasUsing Pulse Wave ImagingSacha Nandlall,* Monica Goldklang, Jeanine d’Armiento,Elisa Konofagou Columbia University, New York, New YorkUSAObjectives—Abdominal Aortic Aneurysms (AAAs) are a commonvascular disease. The leading cause of AAA-induced death is rapid internalbleeding following a sudden rupture of the vessel wall, typicallywithin the sac of the aneurysm. This study aimed at showing that pulsewave imaging (PWI) can be used to differentiate normal murine aortasfrom AAAs, even for aneurysms that are not visible or easily detectable ona standard B-mode. PWI is a noninvasive technique for tracking the propagationof pulse waves along the wall of the aorta at high spatial and temporalresolutions. The velocity of these waves is a well-established markerof wall stiffness, which is closely related to the likelihood of rupture.Methods—An AAA model was generated by infusing 13ApoE/TIMP-1 knockout mice with angiotensin II, delivered at a constantflow rate via subcutaneously implanted osmotic pumps. The suprarenalsections of the abdominal aortas were scanned every 2 to 3 days after implantationusing a Vevo 770 imager (VisualSonics Inc) with axial and lateralresolutions of 55 and 115 µm, respectively. Pulse wave propagationwas tracked at an effective frame rate of 8 kHz by using retrospective electrocardiographicgating. The displacements induced by the pulse waveswere estimated by performing 1D cross-correlation on the pre–beamformedradiofrequency signals.Results—In normal aortas, the pulse waves propagated at constantvelocities (r 2 ≥ 0.9) between 2 and 4 m/s, indicating that the compositionof these vessels was relatively homogeneous. However, in AAAswhere the vessel diameter had increased by at least 50%, the wave speedsexhibited higher variances along the wall (r 2 < 0.9). Moreover, the wall displacementsinduced by the pulse waves were at least 80% lower within theaneurysmal sacs, indicating that the AAAs had a higher relative stiffness.Conclusions—This study demonstrates that PWI can be usedto distinguish normal murine aortas from AAAs based on the higher varianceand lower wall displacements induced by the pulse wave in the lattercase. Hence, PWI could potentially be used to monitor the growth andpropensity for rupture of human aneurysms by providing complementaryinformation to that provided by a standard B-mode.1510020 Results of Evaluation of the Spectral Curve in AortoiliacDiseaseMireia Cussó Sorribas,* Xavier Martí Mestre, Nicolo RizzaSiniscalchi, Sara Garcia Pelegrí, Antonio Romera Villegas,Ramon Vila Coll Vascular Surgery, Hospital de Bellvitge,Hospitalet de Llobregat, Barcelona, SpainObjectives—To evaluate the morphology of the spectral curveof the supraceliac aorta as a complement of the diagnosis of aortoiliac occlusivedisease.Methods—We studied 86 patients (70 men) with a mean age of62 years (range, 16–90 years) recruited from August to February 2012.Arterial Doppler ultrasound of the aortoiliac and femoro-popliteal sectorwas used as a method of diagnosis of the stenotic-occlusive disease inthese sectors. Stenosis was considered significant when it exceeded 70%,characterized by a ratio of peak systolic velocities in the stenosis comparedto the previous stenosis ≥3. Occlusion was considered in the absenceof flow. We determined the spectral wave morphology of the aorticflow at the visceral arteries level looking for the presence of a decelerationin the late systolic phase or a biphasic wave in the systolic waveform(notch). We studied the relationship of these signs of the spectral visceralaortic wave with the presence of disease of the aortoiliac sector in termsof sensitivity, specificity, positive predictive value (PPV), negative predictivevalue (NPV), overall efficiency, and κ correlation index. Data weretreated using SPSS 15.0 for Windows.Results—Fifty-seven percent had aortoiliac disease, and 51.2%had femoro-popliteal disease. We detected the presence of alteration in thespectral visceral aorta wave in 46 patients (53.5%), of which 41 had aortoiliacdisease. The sensitivity, specificity, PPV, and NPV for the morphologicalteration of the aortic spectral curve in the aortoiliac segmentwere 83.6%, 86.5%, 89.1%, and 80%, respectively, with overall efficiencyof 84.9% and a κ correlation index of 0.695 (good agreement).Conclusions—The existence of spectral wave disturbances inthe visceral aortic territory might suggest the presence of stenotic-occlusivedisease in the aortoiliac segment.1530492 Comparison of Automatic and Manual Transcranial SonographicMorphometric Measurement of the Substantia NigraMonika Jelinkova, 1 David Školoudík, 2,3 * Jiri Blahuta, 4 TomasSoukup, 4 Petr Cermak, 4 Petra Bartova, 2 Katerina Langova, 5Roman Herzig 3 1 Neurology, Hospital Karvina-Raj, Karvina,Czech Republic; 2 Neurology, University Hospital Ostrava,Ostrava, Czech Republic; 3 Neurology, Palacký University MedicalSchool and University Hospital Olomouc, Olomouc, CzechRepublic; Institute of Computer Science, Faculty of Philosophyand Science, Silesian University Opava, Opava, CzechRepublic; Biophysics, Faculty of Medicine and Dentistry,Institute of Molecular and Translational Medicine, PalackýUniversity Olomouc, Olomouc, Czech RepublicObjectives—Increased echogenicity of the substantia nigra(SN) is a typical transcranial sonographic (TCS) finding in Parkinson’sdisease (PD). Experimental software for quantitative evaluation of theechogenic SN area was developed to overcome the main limitation ofTCS, the dependency on the sonographer’s experience. The aim of thestudy was to compare the morphometric measurement of the SN usingdeveloped software with manual measurement and results achieved by 2different ultrasound machines in PD patients and healthy volunteers.Methods—Totally, 113 healthy volunteers were enrolled in thederivation cohort and 50 healthy volunteers and 30 PD patients in the validationcohort. The SN was imaged from the right and left temporal bonewindows in the mesencephalic plane using TCS. All subjects were examinedtwice using different sonographic machines (MyLab Twice, Esaote;and Vivid 7 Pro, GE). DICOM images of the SN were saved, encoded, andprocessed. Manual and automatic morphologic measurements of the SNwere performed by an experienced sonographer. The 90th percentile ofderivation cohort values was used as a cut point for the evaluation of ahyperechoic SN in the validation cohort. Spearman’s coefficient was usedfor the assessment of correlation between manual and automatic measurements.Cohen’s κ coefficient was used for the assessment of correlationbetween automatic or manual measurement and PD diagnosis.S34
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