Official Proceedings - AIUM

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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Hands-on How to Do the BiopsyModerator: Dean Nakamoto, MDAfter attending this session, participants will be able to describeprebiopsy preparations, use and have hands-on experience with the techniquesof doing biopsies of soft tissue masses, thyroid nodules, breastmasses, the liver, and kidneys, and recognize and manage complications.SPECIAL INTEREST SESSIONTUESDAY, APRIL 9, 2013, 11:00 AM–12:30 PMSPECIAL INTEREST SESSIONSTUESDAY, APRIL 9, 2013, 1:30 PM–3:30 PMBefore and After: Case Presentations, SurgicalFindings, and Clinical OutcomesModerator: James Shwayder, MD, JDAdnexal MassesJames Shwayder Obstetrics and Gynecology, University ofMississippi Medical Center, Jackson, Mississippi USAThis portion of the session will present clinical cases addressingthe options for diagnosing adnexal masses. Ultrasound findingscomprising morphology, vascular studies, and 3D will be reviewed.The presentations will focus on clinical history and ultrasound findingscorrelated with surgical outcomes.Hands-on Scanning: Peripheral Nerves of theUpper ExtremityModerator: Kenneth Lee, MDAfter attending this session, participants will have gained handsonexperience in scanning the peripheral nerves of the upper extremity.recognition of normal outflow tracts in different orientations will increasethe likelihood of identifying fetuses in which these connections are abnormal.Imaging the 3-vessel view can further help distinguish that theoutflow tracts are normal. Vessel size, alignment, arrangement, number, directionof flow, and turbulent flow at the level of the 3-vessel view provideadditional information about the normalcy of the outflow tracts. Given itshigh prevalence and significant infant morbidity and mortality, universalscreening for congenital heart disease is warranted. Early detection allowsfor an assessment for associated chromosomal, syndromic, or extracardiacabnormalities as well as consideration of pregnancy options and planningfor ongoing obstetric and neonatal care. A thorough evaluation of theoutflow tracts can improve the overall prenatal diagnosis of major fetalheart malformations.Microbubbles and Drug/Gene DeliveryModerators: Christy Holland, PhD, and Kai Thomenius, PhDImproving Sonoporation Delivery and Gene Transfection byControlling Ultrasound Excitation of MicrobubblesCheri Deng Biomedical Engineering, University of Michigan,Ann Arbor, Michigan USALive Fetal Cardiac Scanning by the ExpertsModerator: Lami Yeo, MDBasics of Fetal Cardiac Screening: How to Confirm Normal OutflowTractsLynn Simpson Obstetrics and Gynecology, ColumbiaUniversity Medical Center, New York, New York USAAlthough the majority of pregnant women undergo obstetricultrasound, only a third to one-half of all major congenital heart defects aredetected prior to birth. The 4-chamber view of the fetal heart can identify40% to 50% of major cardiac anomalies. The prenatal detection of heartmalformations can be increased to 60% to 80% when views of the rightand left ventricular outflow tracts are also assessed. It is now recommendedthat in addition to the 4-chamber view, views of the outflow tractsbe evaluated as part of the cardiac screening examination. This has thepotential to increase the identification of conotruncal anomalies that frequentlyare associated with a normal-appearing 4-chamber view. TheS57Microbubble-facilitated disruption of the cell membrane, orsonoporation, has been exploited for nonviral intracellular delivery of therapeuticagents. However, ultrasound-mediated microbubble activities andtheir impact on cells are difficult to control and optimize due to the complexcharacteristics of ultrasound interaction with microbubbles. Theseoften result in low delivery efficiency and variable delivery outcome. Todevelop sonoporation technique to achieve reproducible, robust deliveryoutcomes, we examined the detail characteristics of ultrasound interactionwith microbubbles. The goal of our study is to improve ultrasoundmediatedintracellular delivery and gene transfection by designingultrasound exposure conditions based on the detailed dynamic processesof ultrasound interaction with microbubbles in the context of their impactto cells. We performed experiments using both free microbubbles and targetedmicrobubbles that were attached to a cell membrane via receptor-ligandbinding. We identified 3 distinct regimes of ultrasound excitation oftargeted microbubbles characterized by the rate of microbubble collapseand translational movement (displacement): stable cavitation with minimaldisplacement, coalescence and translation, and rapid collapse (inertialcavitation) with minimal displacement. We quantified and correlated themicrobubble dynamics with the resulting membrane disruption, intracel-
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013lular delivery, and cell viability. We found that rapid collapse of microbubbleswith limited translational movement, typically generated by ultrasoundexcitations with high acoustic pressure and short duration,generated the highest delivery efficiency while maintaining high cell viability.Based on characterization of microbubble activities and membranedisruption, we implemented a 2-pulse ultrasound exposure scheme withramped amplitude to improve gene transfection efficiency in mice (aortic)vascular smooth muscle cells for green fluorescence protein gene transfection.Our results show that rational design of ultrasound exposure parameterscan be obtained from microbubble dynamics to improve deliveryoutcomes.Microbubbles and Gene/Drug Delivery: Future Therapeutic Applicationsof Contrast-Enhanced Ultrasound ImagingSteven Feinstein Cardiology/Medicine, Rush UniversityMedical Center, Chicago, Illinois USAToday, the clinical applications of contrast-enhanced ultrasoundimaging (CEUS) are solely based on diagnostic imaging. It is anticipatedthat the future applications of CEUS will provide a paradigm shift in thefield of therapeutics. In fact, CUES as a therapy uses gas-filled microspheresas intravascular indicators and provides unprecedented microvascularaccess to tissues and organs. Hence, acoustic microspheres are idealcarrier vehicles for ultrasound-based, site-specific drug/gene delivery. Thebasis for devising newer therapeutic options is created by local in vivomicrosphere disruption using externally applied acoustic energy. Basedon data dating to at least to 1995, it appears that the application of therapeuticultrasound delivery systems has a bright future. The advantages ofusing an acoustically medicated system derive from the value of using anonviral, mediated system accompanied by low risk/benefit ratios. Leadingscientists throughout the world have successfully demonstrated nonviraltransduction in a variety of preclinical scenarios. The combinedapplications for diagnosis and therapy provide unique opportunities forclinicians and researchers to image, direct therapy, and monitor individualsduring treatment.Targeted Thrombolysis With Ultrasound and MicrobubblesThomas Porter Section of Cardiology, University ofNebraska Medical Center, Omaha, Nebraska USAUltrasound-induced cavitation has been explored as a methodof dissolving intravascular and microvascular thrombi in acute myocardialinfarction (STEMI). Ongoing studies are being performed to determinethe type of cavitation required for success and whether longer–pulse durationtherapeutic impulses (which sustain the duration of cavitation) couldrestore both microvascular and epicardial flow with this technique. In 36hyperlipidemic atherosclerotic pigs, thrombotic occlusions were inducedin the mid left anterior descending artery. Pigs were then randomized to either(1) ½ dose of tissue plasminogen activator (TPA; 0.5 mg/kg) alone orthe same dose of TPA and an intravenous microbubble infusion witheither (2) guided high–mechanical index (MI) short-pulse (2.0 MI; 5-microsecond) therapeutic ultrasound (TUS) impulses or (3) guided 1.0 MIlong-pulse (20 microsecond) impulses. Passive cavitation detectors indicatedthat the high-MI impulses (both long and short pulse durations)induced inertial cavitation within the microvasculature. Epicardial recanalizationrates at all time points following randomized treatments werehighest in pigs treated with the long–pulse duration TUS impulses (83%vs 59% for short pulse and 49% for TPA alone; P < .05). Even without epicardialrecanalization, however, early microvascular recovery (ST recovery)occurred with both short- and long-pulse TUS impulses (P < .005compared to TPA alone), and wall thickening improved within the riskarea only in pigs treated with ultrasound and microbubbles. These findingsindicate that although short-pulse TUS impulses transiently improve microvascularflow, long-pulse TUS impulses are required to produce sustainedepicardial and microvascular reflow in acute STEMI.New Horizons in Critical Care UltrasoundModerator: Paul Mayo, MDNew Horizons in Critical Care UltrasoundMichael Blaivas Northside Hospital Forsyth, Cumming,Georgia USAPoint-of-care ultrasound has undergone tremendous growth inthe last 5 years, and this has heralded multiple advancements in applicationsand techniques used on critically ill patients. In addition, new equipmentavailable on the market has targeted ultrasound use in the emergencyand critical care settings. Availability of multiple transducer types, highendimaging, and even transesophageal echocardiography has opened thedoor for previously unexplored levels of patient evaluation during the mostcritical presentations. One of the most exciting is the effect ultrasound hashad on the evaluation, diagnosis, and management of the cardiac arrestand periarrest states. This presentation will focus on new applications inpoint-of-care ultrasound for the care and treatment of the cardiac arrestand periarrest patient. Current literature and applications including transesophagealechocardiography in point-of-care and intravascular volumedetermination for immediate clinical decision making in this critically illpatient population will be discussed.Perinatal Malformations of the Head, Face, and NeckModerator: Eva Rubio, MDPerinatal Malformations of the Head, Face, and Neck: HeadBeth Kline-Fath Radiology, Cincinnati Children’s HospitalMedical Center, Cincinnati, Ohio USAUltrasound is an integral part of prenatal care. With regard to thebrain, sonographic imaging offers a rapid noninvasive window. Additionalbenefits of this technique are lack of radiation, portability, and low cost.The ability to use color and Doppler of intracranial vessels is also extremelyvaluable. Prenatal cranial ultrasound provides information regardingcongenital anomalies, masses, and hydrocephalous. Destructive,vascular, hemorrhagic, infectious, and hypoxic ischemic pathologies arealso demonstrated by this technique. In this lecture, the common prenatalabnormalities of the brain will be illustrated with ultrasound imaging. Correlationwith fetal magnetic resonance imaging will also be provided toallow the sonographer to improve imaging technique and anatomy. Theability of prenatal sonography to promptly diagnose these central nervoussystem conditions is invaluable in directing fetal treatment and prenatalcounseling.Perinatal Malformations of the Head, Face, and NeckEva Rubio Children’s National Medical Center, Washington,DC USAThis session will review common, rare, and urgent abnormalitiesof the head, face, and neck seen in the prenatal and early infant period.The timing of prenatal as well as postnatal imaging of these lesions, imagingparameters, and current recommendations will be discussed. Whatdo the surgeons need to know, and what kind of team needs to be assembledfor the most challenging cases? How should parents be counseled?This session will be both didactic and interactive.S58
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Small-Animal Preclinical High-Frequ
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2013 AIUM Award WinnersJoseph H. Ho
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2013 AIUM Award WinnersDistinguishe
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Endowment for Education andResearch
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Rosa De Vermette, MD, RDCS,RDMS, RO
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Kee-Hak Lim, MDG. Sharat Lin, PhDTo
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