[Image quality and detection of pathology by ultrasound: comparison of B-mode ultrasound with photopic imaging and tissue harmonic imaging alone and in combination]

Prospective Comparison of Handheld Ultrasound Devices from Different Manufacturers with Respect to B-Scan Quality and Clinical Significance for Various Abdominal Sonography Questions

BACKGROUND

Handheld ultrasound (HHUS) devices have chiefly been deployed in emergency medicine, where they are considered a valid tool. The data situation is less clear in the case of internal questions in abdominal sonography. In our study, we investigate whether HHUS devices from different manufacturers differ in their B-scan quality, and whether any differences are relevant for the significance of an internal ultrasound examination.

METHOD

The study incorporated eight HHUS devices from different manufacturers. Ultrasound videos of seven defined sonographic questions were recorded with all of the devices. The analogue recording of the same findings with a conventional high-end ultrasound (HEUS) device served as an evaluation criterion. Then, the corresponding findings were played side by side and evaluated by fourteen ultrasound experts using a point scale (5 points = very good; 1 point = insufficient).

RESULTS

The HHUS devices achieved relatively good results in terms of both the B-scan quality assessment and the ability to answer the clinical question, regardless of the manufacturer. One of the tested HHUS devices even achieved a significantly (p < 0.05) higher average points score in both the evaluation of B-scan quality and in the evaluation of clinical significance than the other devices. Regardless of the manufacturer, the HHUS devices performed best when determining the status/inferior vena cava volume and in the representation of ascites/free fluid.

CONCLUSION

In various clinical abdominal sonography questions, HHUS systems can reliably reproduce findings, and are-while bearing their limitations in mind-an acceptable alternative to conventional HEUS systems. Irrespective of this, the present study demonstrated relevant differences in the B-scan quality of HHUS devices from different manufacturers.

Comparison Between Various Color Spectra and Conventional Grayscale Imaging for Detection of Parenchymal Liver Lesions With B-Mode Sonography

OBJECTIVES

The electronic colorization of grayscale B-mode sonograms using various color schemes aims to enhance the adaptability and practicability of B-mode sonography in daylight conditions. The purpose of this study was to determine the diagnostic effectiveness and importance of colorized B-mode sonography.

METHODS

Fifty-three video sequences of sonographic examinations of the liver were digitized and subsequently colorized in 2 different color combinations (yellow-brown and blue-white). The set of 53 images consisted of 33 with isoechoic masses, 8 with obvious lesions of the liver (hypoechoic or hyperechoic), and 12 with inconspicuous reference images of the liver. The video sequences were combined in a random order and edited into half-hour video clips.

RESULTS

Isoechoic liver lesions were successfully detected in 58% of the yellow-brown video sequences and in 57% of the grayscale video sequences (P = .74, not significant). Fifty percent of the isoechoic liver lesions were successfully detected in the blue-white video sequences, as opposed to a 55% detection rate in the corresponding grayscale video sequences (P= .11, not significant). In 2 subgroups, significantly more liver lesions were detected with grayscale sonography compared to blue-white sonography.

CONCLUSIONS

Yellow-brown-colorized B-mode sonography appears to be similarly effective for detection of isoechoic parenchymal liver lesions as traditional grayscale sonography. Blue-white colorization in B-mode sonography is probably not as effective as grayscale sonography, although a statistically significant disadvantage was shown only in the subgroup of hyperechoic liver lesions.

[Modern gray-scale sonography of the breast]

Recently, the diagnosis of breast diseases by ultrasound has changed radically. It is no longer a complementary modality to mammography but a separate method to investigate breast disease. Innovative high-resolution ultrasound allows more specific diagnosis of breast tumors. Tissue-harmonic imaging not only uses the transmitted, fundamental frequency to obtain an image but also the harmonic frequency. The harmonic signal is processed by the ultrasound system with the result of better delineation of tissue structures and spatial compounding assembles an image from multiple images taken from different angles of echo waves. The effect is the reduction of artifacts with optimized contrast. Finally the advanced speckle reduction technique is used to smooth and homogenize the image. Additionally continuous advancement of new high-resolution linear transducers is responsible for the essential improvement of image quality. In conclusion, it is recommended to integrate all of the described modalities in order to obtain diagnostically conclusive image quality. This article demonstrates the new techniques and applications exemplified using images.

The role of intraoperative ultrasonography in zygomatic complex fracture repair

Intraoperative assessment of the zygomatic arch is very important in achieving adequate repositioning. The correct alignment of the zygomatic arch indicates the proper position of the zygomatic bone and ensures adequate prominence of the lateral midfacial aspect. The aim of this study was to estimate the value of ultrasonography as an intraoperative repositioning control. In a clinical study of 25 patients, ultrasonography was employed for intraoperative visualization of the zygomatic arch before and after fracture repositioning. Twelve patients presented with isolated zygomatic arch fractures and 13 with combined fractures of the zygomatic bone and arch. The ultrasonographic findings were compared to the radiological and clinical findings. Ultrasonography was able to detect all fractures and dislocations of the zygomatic arch. It was possible to assess the repositioning in 24 out of 25 cases using ultrasonography. The ultrasound images were concordant with the radiographs. Clinical assessment by palpation only succeeded in isolated zygomatic arch fractures with an m-shaped impression, whereas it remained uncertain in nearly all cases with a different dislocation pattern. Ultrasonography was rapid and easy to perform, and is recommended as an intraoperative visualizing tool in all midfacial fractures with displacement of the zygomatic arch.

Ultrasonic biomedical technology; marketing versus clinical reality

Clinical ultrasound imaging is the most frequently used imaging modality in the world accounting for almost 25% of all imaging studies performed. Hence, manufacturers of commercial ultrasound equipment are committing significant engineering resources to advance the technology behind the modality and to improve the diagnostic capabilities of ultrasound imaging. Consequently, new imaging technologies are constantly being introduced to the market under a host of different trademarked names. Hence, this paper will review many of the recent advances in ultrasound imaging and try to differentiate between developments aimed at marketing and those providing real clinical improvements. In particular, we will describe the technologies behind concepts such as coded ultrasound imaging, real time spatial compounding, tissue harmonic imaging, extended field of view imaging as well as 3D and 4D (i.e., real time 3D) imaging. Some of the latest advances in blood flow imaging e.g., B-flow, advanced dynamic flow (ADF) and automatic optimization methods will also be described.