Evaluation of bone-tendon junction healing using water jet ultrasound indentation method

Clinical Evaluation of a 3-D Automatic Annotation Method for Breast Ultrasound Imaging

The routine clinical breast ultrasound annotation method is limited by the time it consumes, inconsistency, inaccuracy and incomplete notation. A novel 3-D automatic annotation method for breast ultrasound imaging has been developed that uses a spatial sensor to track and record conventional B-mode scanning so as to provide more objective annotation. The aim of the study described here was to test the feasibility of the automatic annotation method in clinical breast ultrasound scanning. An ultrasound scanning procedure using the new method was established. The new method and the conventional manual annotation method were compared in 46 breast cancer patients (49 ± 12 y). The time used for scanning a patient was recorded and compared for the two methods. Intra-observer and inter-observer experiments were performed, and intra-class correlation coefficients (ICCs) were calculated to analyze system reproducibility. The results revealed that the new annotation method had an average scanning time 36 s (42.9%) less than that of the conventional method. There were high correlations between the results of the two annotation methods (r = 0.933, p < 0.0001 for distance; r = 0.995, p < 0.0001 for radial angle). Intra-observer and inter-observer reproducibility was excellent, with all ICCs > 0.92. The results indicated that the 3-D automatic annotation method is reliable for clinical breast ultrasound scanning and can greatly reduce scanning time. Although large-scale clinical studies are still needed, this work verified that the new annotation method has potential to be a valuable tool in breast ultrasound examination.

Phytomolecule icaritin incorporated PLGA/TCP scaffold for steroid-associated osteonecrosis: Proof-of-concept for prevention of hip joint collapse in bipedal emus and mechanistic study in quadrupedal rabbits

Steroid-associated osteonecrosis (SAON) may lead to joint collapse and subsequent joint replacement. Poly lactic-co-glycolic acid/tricalcium phosphate (P/T) scaffold providing sustained release of icaritin (a metabolite of Epimedium-derived flavonoids) was investigated as a bone defect filler after surgical core-decompression (CD) to prevent femoral head collapse in a bipedal SAON animal model using emu (a large flightless bird). The underlying mechanism on SAON was evaluated using a well-established quadrupedal rabbit model. Fifteen emus were established with SAON, and CD was performed along the femoral neck for the efficacy study. In this CD bone defect, a P/T scaffold with icaritin (P/T/I group) or without icaritin (P/T group) was implanted while no scaffold implantation was used as a control. For the mechanistic study in rabbits, the effects of icaritin and composite scaffolds on bone mesenchymal stem cells (BMSCs) recruitment, osteogenesis, and anti-adipogenesis were evaluated. Our efficacy study showed that P/T/I group had the significantly lowest incidence of femoral head collapse, better preserved cartilage and mechanical properties supported by more new bone formation within the bone tunnel. For the mechanistic study, our in vitro tests suggested that icaritin enhanced the expression of osteogenesis related genes COL1α, osteocalcin, RUNX2, and BMP-2 while inhibited adipogenesis related genes C/EBP-ß, PPAR-γ, and aP2 of rabbit BMSCs. Both P/T and P/T/I scaffolds were demonstrated to recruit BMSCs both in vitro and in vivo but a higher expression of migration related gene VCAM1 was only found in P/T/I group in vitro. In conclusion, both efficacy and mechanistic studies show the potential of a bioactive composite porous P/T scaffold incorporating icaritin to enhance bone defect repair after surgical CD and prevent femoral head collapse in a bipedal SAON emu model.

A new method for evaluating the degeneration of articular cartilage using pulse-echo ultrasound

This paper presents a novel nondestructive ultrasonic technique for measuring the sound speed and acoustic impedance of articular cartilage using the pulsed Vz,t technique. Vz,t data include a series of pulsed ultrasonic echoes collected using different distances between the ultrasonic transducer and the specimen. The 2D Fourier transform is applied to the Vz,t data to reconstruct the 2D reflection spectrum Rθ,ω. To obtain the reflection coefficient of articular cartilage, the Vz,t data from a reference specimen with a well-known reflection coefficient are obtained to eliminate the dependence on the general system transfer function. The ultrasound-derived aggregate modulus (Ha) is computed based on the measured reflection coefficient and the sound speed. In the experiment, 32 cartilage-bone samples were prepared from bovine articular cartilage, and 16 samples were digested using 0.25% trypsin solution. The sound speed and Ha of these cartilage samples were evaluated before and after degeneration. The magnitude of the sound speed decreased with trypsin digestion (from 1663 ± 5.6 m/s to 1613 ± 5.3 m/s). Moreover, the Young's modulus in the corresponding degenerative state was measured and was correlated with the ultrasound-derived aggregate modulus. The ultrasound-derived aggregate modulus was determined to be highly correlated with the Young's modulus (n = 16, r>0.895, p<0.003, Pearson correlation test for each measurement). The results demonstrate the effectiveness of using the proposed method to assess the changes in sound speed and the ultrasound-derived aggregate modulus of cartilage after degeneration.

Pre-clinical characterization of tissue engineering constructs for bone and cartilage regeneration

Pre-clinical animal models play a crucial role in the translation of biomedical technologies from the bench top to the bedside. However, there is a need for improved techniques to evaluate implanted biomaterials within the host, including consideration of the care and ethics associated with animal studies, as well as the evaluation of host tissue repair in a clinically relevant manner. This review discusses non-invasive, quantitative, and real-time techniques for evaluating host-materials interactions, quality and rate of neotissue formation, and functional outcomes of implanted biomaterials for bone and cartilage tissue engineering. Specifically, a comparison will be presented for pre-clinical animal models, histological scoring systems, and non-invasive imaging modalities. Additionally, novel technologies to track delivered cells and growth factors will be discussed, including methods to directly correlate their release with tissue growth.

A semi-automated 3-D annotation method for breast ultrasound imaging: system development and feasibility study on phantoms

Spatial annotation is an essential step in breast ultrasound imaging, because the follow-up diagnosis and treatment are based on this annotation. However, the current method for annotation is manual and highly dependent on the operator's experience. Moreover, important spatial information, such as the probe tilt angle, cannot be indicated in the clinical 2-D annotations. To solve these problems, we developed a semi-automated 3-D annotation method for breast ultrasound imaging. A spatial sensor was fixed on an ultrasound probe to obtain the image spatial data. Three-dimensional virtual models of breast and probe were used to annotate image locations. After the reference points were recorded, this system displayed the image annotations automatically. Compared with the conventional manual annotation method, this new annotation system has higher accuracy as indicated by the phantom test results. In addition, this new annotation method has good repeatability, with intra-class correlation coefficients of 0.907 (average variation: ≤3.45%) and 0.937 (average variation: ≤2.85%) for the intra-rater and inter-rater tests, respectively. Breast phantom experiments simulating clinical breast scanning further indicated the feasibility of this system for clinical applications. This new annotation method is expected to facilitate more accurate, intuitive and rapid breast ultrasound diagnosis.

Quantitative imaging of young's modulus of soft tissues from ultrasound water jet indentation: a finite element study

Indentation testing is a widely used approach to evaluate mechanical characteristics of soft tissues quantitatively. Young's modulus of soft tissue can be calculated from the force-deformation data with known tissue thickness and Poisson's ratio using Hayes' equation. Our group previously developed a noncontact indentation system using a water jet as a soft indenter as well as the coupling medium for the propagation of high-frequency ultrasound. The novel system has shown its ability to detect the early degeneration of articular cartilage. However, there is still lack of a quantitative method to extract the intrinsic mechanical properties of soft tissue from water jet indentation. The purpose of this study is to investigate the relationship between the loading-unloading curves and the mechanical properties of soft tissues to provide an imaging technique of tissue mechanical properties. A 3D finite element model of water jet indentation was developed with consideration of finite deformation effect. An improved Hayes' equation has been derived by introducing a new scaling factor which is dependent on Poisson's ratios v, aspect ratio a/h (the radius of the indenter/the thickness of the test tissue), and deformation ratio d/h. With this model, the Young's modulus of soft tissue can be quantitatively evaluated and imaged with the error no more than 2%.

Quantitative assessment of articular cartilage with morphologic, acoustic and mechanical properties obtained using high-frequency ultrasound

Osteoarthritis (OA) is one of the most common joint diseases among adults, and its early detection is still not possible. In this study, high-frequency ultrasound and ultrasound-assisted mechanical testing systems were used to quantitatively measure the morphologic, acoustic and mechanical properties of normal and enzymatically degraded bovine articular cartilages in vitro. A total of 40 osteochondral cartilage plugs were prepared from 20 bovine patellae (n=20x2) and divided into two groups for collagenase and trypsin digestions, respectively. A high-frequency ultrasound system (center frequency: 40 MHz) was used to analyze the surface integrity (ultrasound roughness index, URI), thickness and acoustic properties of the articular cartilages before and after enzymatic degradations. Acoustic parameters included the integrated reflection coefficient (IRC) from the cartilage surface, reflection from the cartilage-bone interface (AIB(bone)), integrated attenuation (IA) and integrated backscatter (IBS) of the internal cartilage tissue. A newly developed ultrasound water jet indentation system was used to assess the mechanical properties of the cartilage samples. The results showed that the URI increased significantly (p<0.05) after collagenase digestion while no significant change (p>0.05) was found after trypsin digestion. With regard to acoustic parameters, the IRC decreased significantly (p<0.05) after collagenase digestion while no significant change (p>0.05) was found after trypsin digestion. The AIB(bone) demonstrated an insignificant change after collagenase digestion (p>0.05) but a significant decrease after trypsin digestion (p<0.05). Both enzymatic degradation groups showed insignificant differences (p>0.05) in the IA but a significant increase (p<0.05) in the IBS after both enzymatic degradations. The apparent stiffness measured by ultrasound water jet indentation suggested that articular cartilage from both groups became significantly softer (p<0.05) after the enzymatic degradations. A significant relationship was found to exist between the IRC and URI (p<0.05). This study showed that high-frequency ultrasound can be a comprehensive tool to quantitatively and systematically analyze the morphologic, acoustic and mechanical properties of articular cartilage in association with its degeneration.