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Chen C, Turco S, Kapetas P, Mann R, Wijkstra H, de Korte C, Mischi M. Spatiotemporal analysis of contrast-enhanced ultrasound for differentiating between malignant and benign breast lesions. Eur Radiol 2023:10.1007/s00330-023-10500-x. [PMID: 38112765 DOI: 10.1007/s00330-023-10500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES The aim of this study was to apply spatiotemporal analysis of contrast-enhanced ultrasound (CEUS) loops to quantify the enhancement heterogeneity for improving the differentiation between benign and malignant breast lesions. MATERIALS AND METHODS This retrospective study included 120 women (age range, 18-82 years; mean, 52 years) scheduled for ultrasound-guided biopsy. With the aid of brightness-mode images, the border of each breast lesion was delineated in the CEUS images. Based on visual evaluation and quantitative metrics, the breast lesions were categorized into four grades of different levels of contrast enhancement. Grade-1 (hyper-enhanced) and grade-2 (partly-enhanced) breast lesions were included in the analysis. Four parameters reflecting enhancement heterogeneity were estimated by spatiotemporal analysis of neighboring time-intensity curves (TICs). By setting the threshold on mean parameter, the diagnostic performance of the four parameters for differentiating benign and malignant lesions was evaluated. RESULTS Sixty-four of the 120 patients were categorized as grade 1 or 2 and used for estimating the four parameters. At the pixel level, mutual information and conditional entropy present significantly different values between the benign and malignant lesions (p < 0.001 in patients of grade 1, p = 0.002 in patients of grade 1 or 2). For the classification of breast lesions, mutual information produces the best diagnostic performance (AUC = 0.893 in patients of grade 1, AUC = 0.848 in patients of grade 1 or 2). CONCLUSIONS The proposed spatiotemporal analysis for assessing the enhancement heterogeneity shows promising results to aid in the diagnosis of breast cancer by CEUS. CLINICAL RELEVANCE STATEMENT The proposed spatiotemporal method can be developed as a standardized software to automatically quantify the enhancement heterogeneity of breast cancer on CEUS, possibly leading to the improved diagnostic accuracy of differentiation between benign and malignant lesions. KEY POINTS • Advanced spatiotemporal analysis of ultrasound contrast-enhanced loops for aiding the differentiation of malignant or benign breast lesions. • Four parameters reflecting the enhancement heterogeneity were estimated in the hyper- and partly-enhanced breast lesions by analyzing the neighboring pixel-level time-intensity curves. • For the classification of hyper-enhanced breast lesions, mutual information produces the best diagnostic performance (AUC = 0.893).
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Affiliation(s)
- Chuan Chen
- Eindhoven University of Technology, Eindhoven, Netherlands.
- Southeast University, Nanjing, China.
| | - Simona Turco
- Eindhoven University of Technology, Eindhoven, Netherlands
| | | | - Ritse Mann
- Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Chris de Korte
- Medical University of Vienna, Vienna, Austria
- University of Twente, Enschede, Netherlands
| | - Massimo Mischi
- Eindhoven University of Technology, Eindhoven, Netherlands
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Chen C, Perera R, Kolios MC, Wijkstra H, Mischi M, Exner AA, Turco S. Pharmacokinetic modeling of PSMA-targeted nanobubbles for quantification of extravasation and binding in mice models of prostate cancer. Med Phys 2022; 49:6547-6559. [PMID: 36049109 PMCID: PMC9588563 DOI: 10.1002/mp.15962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/20/2022] [Accepted: 08/19/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Contrast-enhanced ultrasound (CEUS) by injection of microbubbles (MBs) has shown promise as a cost-effective imaging modality for prostate cancer (PCa) detection. More recently, nanobubbles (NBs) have been proposed as novel ultrasound contrast agents. Unlike MBs, which are intravascular ultrasound contrast agents, the smaller diameter of NBs allows them to cross the vessel wall and target specific receptors on cancer cells such as the prostate-specific membrane antigen (PSMA). It has been demonstrated that PSMA-targeted NBs can bind to the receptors of PCa cells and show a prolonged retention effect in dual-tumor mice models. However, the analysis of the prolonged retention effect has so far been limited to qualitative or semi-quantitative approaches. METHODS This work introduces two pharmacokinetics models for quantitative analysis of time-intensity curves (TICs) obtained from the CEUS loops. The first model is based on describing the vascular input by the modified local density random walk (mLDRW) model and independently interprets TICs from each tumor lesion. Differently, the second model is based on the reference-tissue model, previously proposed in the context of nuclear imaging, and describes the binding kinetics of an indicator in a target tissue by using a reference tissue where binding does not occur. RESULTS Our results show that four estimated parameters, β,β / λ $\beta /\lambda $ ,β + / β - ${\beta }_ + /{\beta }_ - $ , for the mLDRW-input model, and γ for the reference-based model, were significantly different (p-value <0.05) between free NBs and PSMA-NBs. These parameters estimated by the two models demonstrate different behaviors between PSMA-targeted and free NBs. CONCLUSIONS These promising results encourage further quantitative analysis of targeted NBs for improved cancer diagnostics and characterization.
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Affiliation(s)
- Chuan Chen
- Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Reshani Perera
- Case Western Reserve University, Cleveland, Ohio, United States
| | | | - Hessel Wijkstra
- Eindhoven University of Technology, Eindhoven, the Netherlands
- Universtity Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Massimo Mischi
- Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Agata A. Exner
- Case Western Reserve University, Cleveland, Ohio, United States
| | - Simona Turco
- Eindhoven University of Technology, Eindhoven, the Netherlands
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3
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The unique second wave phenomenon in contrast enhanced ultrasound imaging with nanobubbles. Sci Rep 2022; 12:13619. [PMID: 35948582 PMCID: PMC9365822 DOI: 10.1038/s41598-022-17756-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/30/2022] [Indexed: 12/19/2022] Open
Abstract
Investigation of nanobubble (NB) pharmacokinetics in contrast-enhanced ultrasound (CEUS) at the pixel level shows a unique phenomenon where the first pass of the contrast agent bolus is accompanied by a second wave. This effect has not been previously observed in CEUS with microbubbles. The objective of this study was to investigate this second-wave phenomenon and its potential clinical applications. Seven mice with a total of fourteen subcutaneously-implanted tumors were included in the experiments. After injecting a bolus of NBs, the NB-CEUS images were acquired to record the time-intensity curves (TICs) at each pixel. These TICs are fitted to a pharmacokinetic model which we designed to describe the observed second-wave phenomenon. The estimated model parameters are presented as parametric maps to visualize the characteristics of tumor lesions. Histological analysis was also conducted in one mouse to compare the molecular features of tumor tissue with the obtained parametric maps. The second-wave phenomenon is evidently shown in a series of pixel-based TICs extracted from either tumor or tissues. The value of two model parameters, the ratio of the peak intensities of the second over the first wave, and the decay rate of the wash-out process present large differences between malignant tumor and normal tissue (0.04 < Jessen-Shannon divergence < 0.08). The occurrence of a second wave is a unique phenomenon that we have observed in NB-CEUS imaging of both mouse tumor and tissue. As the characteristics of the second wave are different between tumor and tissue, this phenomenon has the potential to support the diagnosis of cancerous lesions.
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The Application Value of Contrast-Enhanced Ultrasound in Testicular Occupied Lesions. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:9962970. [PMID: 34194540 PMCID: PMC8214501 DOI: 10.1155/2021/9962970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
Objective To discuss the clinical application value of contrast-enhanced ultrasound (CEUS) in testicular occupied lesions. Methods Nine conventional-ultrasound-found testicular occupied lesions which underwent CEUS meantime were analyzed retrospectively. The CEUS perfusion pattern was compared with the surgical pathological result or follow-up findings. Results Among all the 9 testicular occupied lesions, there were 5 testicular malignant tumors, 1 testicular benign tumor, 1 testicular tuberculosis, and 2 testicular hematomas. CEUS diagnosed 6 testicular malignant tumors, 1 testicular benign tumor, and 2 testicular hematomas, and its diagnostic accuracy was about 88.9%. Conclusion CEUS has high clinical application value in the differential diagnoses of benign and malignant testicular occupied lesions.
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Lu DY, Liu L, Shen L, Cai JR, Xu L, Xiang LH. Comparison of contrast-enhanced ultrasound targeted biopsies versus standard systematic biopsies for prostate cancer correction in different PSA value groups in rural China. Clin Hemorheol Microcirc 2021; 77:295-301. [PMID: 33252065 DOI: 10.3233/ch-200993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate prostate cancer detection rate of different biopsy protocols in different PSA value groups in rural China. METHODS A total of 186 patients underwent contrast-enhanced ultrasound (CEUS) in order to determine the puncture target prior to biopsy were enrolled in this retrospective study. All patients underwent 12-core SB combined with CEUS-TB. The biopsy results of different biopsy protocols were compared in patients with stratification by PSA value. RESULTS Among the 186 patients underwent prostate biopsy, the histopathologic results revealed prostate cancer (PCa) in 117 cases (62.9%) and benign lesions in 69 cases (37.1%). The PCa detection rate between 8-core SB and 12-core SB showed no significant difference in PSA 4-10 ng/ml group, while the 12-core SB was significantly higher than CEUS-TB (44.9% versus 32.7%, P = 0.01). In PSA 10-20 ng/ml group, the significant difference was not seen between SB and CEUS-TB (50.0% versus 45.7%, P = 0.15). As for PSA greater than 20 ng/ml group, the PCa detection rate by SB was higher than CEUS-TB, but showed no statistically significance (79.1% versus 76.9%, P = 0.15). In the overall patients, the biopsy core positive rate of CEUS-TB was significantly higher than SB (97% versus 55.5% and 28.5%, P = 0.0001). CONCLUSION The flexible use of SB combined with CEUS-TB can reduce the number of biopsy cores in higher PSA groups. It has clinical importance in the detection of PCa in different PSA value groups in rural China.
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Affiliation(s)
- Dian Yuan Lu
- Department of Ultrasound in Medicine, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Liu
- Department of Ultrasound in Medicine, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Shen
- Department of Ultrasound in Medicine, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Rong Cai
- Department of Ultrasound in Medicine, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Xu
- Department of Ultrasound in Medicine, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Serkova NJ, Glunde K, Haney CR, Farhoud M, De Lille A, Redente EF, Simberg D, Westerly DC, Griffin L, Mason RP. Preclinical Applications of Multi-Platform Imaging in Animal Models of Cancer. Cancer Res 2021; 81:1189-1200. [PMID: 33262127 PMCID: PMC8026542 DOI: 10.1158/0008-5472.can-20-0373] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/10/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022]
Abstract
In animal models of cancer, oncologic imaging has evolved from a simple assessment of tumor location and size to sophisticated multimodality exploration of molecular, physiologic, genetic, immunologic, and biochemical events at microscopic to macroscopic levels, performed noninvasively and sometimes in real time. Here, we briefly review animal imaging technology and molecular imaging probes together with selected applications from recent literature. Fast and sensitive optical imaging is primarily used to track luciferase-expressing tumor cells, image molecular targets with fluorescence probes, and to report on metabolic and physiologic phenotypes using smart switchable luminescent probes. MicroPET/single-photon emission CT have proven to be two of the most translational modalities for molecular and metabolic imaging of cancers: immuno-PET is a promising and rapidly evolving area of imaging research. Sophisticated MRI techniques provide high-resolution images of small metastases, tumor inflammation, perfusion, oxygenation, and acidity. Disseminated tumors to the bone and lung are easily detected by microCT, while ultrasound provides real-time visualization of tumor vasculature and perfusion. Recently available photoacoustic imaging provides real-time evaluation of vascular patency, oxygenation, and nanoparticle distributions. New hybrid instruments, such as PET-MRI, promise more convenient combination of the capabilities of each modality, enabling enhanced research efficacy and throughput.
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Affiliation(s)
- Natalie J Serkova
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
- Animal Imaging Shared Resource, University of Colorado Cancer Center, Aurora, Colorado
| | - Kristine Glunde
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology, and the Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Chad R Haney
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, Illinois
| | | | | | | | - Dmitri Simberg
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David C Westerly
- Animal Imaging Shared Resource, University of Colorado Cancer Center, Aurora, Colorado
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lynn Griffin
- Department of Radiology, Veterinary Teaching Hospital, Colorado State University, Fort Collins, Colorado
| | - Ralph P Mason
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
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In vitro analysis of the trajectories of adhesive microbubbles approaching endothelial cells. J Colloid Interface Sci 2020; 578:758-767. [PMID: 32574909 DOI: 10.1016/j.jcis.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/21/2022]
Abstract
Adhesion is a key process when ultrasound contrast agents, i.e. microbubbles, approach pathological tissues. A way to accomplish tumour targeting is to tether surface engineered microbubbles to endothelial cells of the up-regulated vascularization of cancer tissues. This can be achieved by coupling the microbubbles surface with the Arginine-Glycine-Aspartate, RGD, sequence. Such molecule interacts with the integrin receptors placed on the endothelial cells. Stability and trajectories of RGD modified lipid shelled MBs have been analysed in vitro using microchannels coated with human umbilical vein endothelial cells, HUVEC. In the microchannels realistic conditions, close to the physiological ones, were reproduced replicating shear rate, roughness comparable to the endothelium and channel size mimicking the postcapillary venules. In these conditions, the analysis of the trajectories close to the walls highlights a substantial difference between the modified MBs and the plain ones. Moreover, MBs adhesion has dynamic features recalling the motion of neutrophils engaged near the substrate such as rolling, translations and transient detachments. These findings are useful for the optimization of in vivo imaging and targeting functions.
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Turco S, El Kaffas A, Zhou J, Lutz AM, Wijkstra H, Willmann JK, Mischi M. Pharmacokinetic Modeling of Targeted Ultrasound Contrast Agents for Quantitative Assessment of Anti-Angiogenic Therapy: a Longitudinal Case-Control Study in Colon Cancer. Mol Imaging Biol 2020; 21:633-643. [PMID: 30225758 PMCID: PMC6616210 DOI: 10.1007/s11307-018-1274-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate quantitative and semi-quantitative ultrasound molecular imaging (USMI) for antiangiogenic therapy monitoring in human colon cancer xenografts in mice. PROCEDURES Colon cancer was established in 17 mice by injection of LS174T (Nr = 9) or CT26 (Nn = 8) cancer cells to simulate clinical responders and non-responders, respectively. Antiangiogenic treatment (bevacizumab; Nrt = Nnt = 5) or control treatment (saline; Nrc = 4, Nnc = 3) was administered at days 0, 3, and 7. Three-dimensional USMI was performed by injection at days 0, 1, 3, 7, and 10 of microbubbles targeted to the vascular endothelial growth factor receptor 2 (VEGFR2). Microbubble binding rate (kb), estimated by first-pass binding model fitting, and semi-quantitative parameters late enhancement (LE) and differential targeted enhancement (dTE) were compared at each day to evaluate their ability to assess and predict the response to therapy. Correlation analysis with the ex-vivo immunohistological quantification of VEGFR2 expression and the percentage blood vessel area was also performed. RESULTS Significant changes in the USMI parameters during treatment were observed only in the responders treated with bevacizumab (p-value < 0.05). Prediction of the response to therapy as early as 1 day after treatment was achieved by the quantitative parameter kb (p-value < 0.01), earlier than possible by tumor volume quantification. USMI parameters could significantly distinguish between clinical responders and non-responders (p-value << 0.01) and correlated well with the ex-vivo quantification of VEGFR2 expression and the percentage blood vessels area (p-value << 0.01). CONCLUSION USMI (semi)quantitative parameters provide earlier assessment of the response to therapy compared to tumor volume, permit early prediction of non-responders, and correlate well with ex-vivo angiogenesis biomarkers.
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Affiliation(s)
- Simona Turco
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 19, 5612 AZ, Eindhoven, The Netherlands.
| | - Ahmed El Kaffas
- Department of Radiology, Stanford Medicine, Stanford, CA, 94305, USA
| | - Jianhua Zhou
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Amelie M Lutz
- Department of Radiology, Stanford Medicine, Stanford, CA, 94305, USA
| | - Hessel Wijkstra
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 19, 5612 AZ, Eindhoven, The Netherlands
- Department of Urology, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - Jürgen K Willmann
- Department of Radiology, Stanford Medicine, Stanford, CA, 94305, USA
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 19, 5612 AZ, Eindhoven, The Netherlands
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Turco S, Frinking P, Wildeboer R, Arditi M, Wijkstra H, Lindner JR, Mischi M. Contrast-Enhanced Ultrasound Quantification: From Kinetic Modeling to Machine Learning. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:518-543. [PMID: 31924424 DOI: 10.1016/j.ultrasmedbio.2019.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 05/14/2023]
Abstract
Ultrasound contrast agents (UCAs) have opened up immense diagnostic possibilities by combined use of indicator dilution principles and dynamic contrast-enhanced ultrasound (DCE-US) imaging. UCAs are microbubbles encapsulated in a biocompatible shell. With a rheology comparable to that of red blood cells, UCAs provide an intravascular indicator for functional imaging of the (micro)vasculature by quantitative DCE-US. Several models of the UCA intravascular kinetics have been proposed to provide functional quantitative maps, aiding diagnosis of different pathological conditions. This article is a comprehensive review of the available methods for quantitative DCE-US imaging based on temporal, spatial and spatiotemporal analysis of the UCA kinetics. The recent introduction of novel UCAs that are targeted to specific vascular receptors has advanced DCE-US to a molecular imaging modality. In parallel, new kinetic models of increased complexity have been developed. The extraction of multiple quantitative maps, reflecting complementary variables of the underlying physiological processes, requires an integrative approach to their interpretation. A probabilistic framework based on emerging machine-learning methods represents nowadays the ultimate approach, improving the diagnostic accuracy of DCE-US imaging by optimal combination of the extracted complementary information. The current value and future perspective of all these advances are critically discussed.
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Affiliation(s)
- Simona Turco
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | | | - Rogier Wildeboer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel Arditi
- École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Hessel Wijkstra
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jonathan R Lindner
- Knight Cardiovascular Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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10
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Wildeboer RR, van Sloun RJG, Huang P, Wijkstra H, Mischi M. 3-D Multi-parametric Contrast-Enhanced Ultrasound for the Prediction of Prostate Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2713-2724. [PMID: 31300222 DOI: 10.1016/j.ultrasmedbio.2019.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/23/2019] [Accepted: 05/16/2019] [Indexed: 05/14/2023]
Abstract
Trans-rectal ultrasound-guided 12-core systematic biopsy (SBx) is the standard diagnostic pathway for prostate cancer (PCa) because of a lack of sufficiently accurate imaging. Quantification of 3-D dynamic contrast-enhanced ultrasound (US) might open the way for a targeted procedure in which biopsies are directed at lesions suspicious on imaging. This work describes the expansion of contrast US dispersion imaging algorithms to 3-D and compares its performance against malignant and benign disease. Furthermore, we examined the feasibility of a multi-parametric approach to predict SBx-core outcomes using machine learning. An area under the receiver operating characteristic (ROC) curve of 0.76 and 0.81 was obtained for all PCa and significant PCa, respectively, an improvement over previous US methods. We found that prostatitis, in particular, was a source of false-positive readings.
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Affiliation(s)
- Rogier R Wildeboer
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Ruud J G van Sloun
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Pintong Huang
- Department of Ultrasonography, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Hessel Wijkstra
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Massimo Mischi
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Herbst EB, Unnikrishnan S, Klibanov AL, Mauldin FW, Hossack JA. Validation of Normalized Singular Spectrum Area as a Classifier for Molecularly Targeted Microbubble Adherence. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2493-2501. [PMID: 31227262 PMCID: PMC7480935 DOI: 10.1016/j.ultrasmedbio.2019.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 05/24/2023]
Abstract
Ultrasound molecular imaging is a diagnostic technique wherein molecularly targeted microbubble contrast agents are imaged to reveal disease markers on the blood vessel endothelium. Currently, microbubble adhesion to affected tissue can be quantified using differential targeted enhancement (dTE), which measures the late enhancement of adherent microbubbles through administration of destructive ultrasound pressures. In this study, we investigated a statistical parameter called the normalized singular spectrum area (NSSA) as a means to detect microbubble adhesion without microbubble destruction. We compared the signal differentiation capability of NSSA with matched dTE measurements in a mouse hindlimb tumor model. Results indicated that NSSA-based signal classification performance matches dTE when differentiating adherent microbubble from non-adherent microbubble signals (receiver operating characteristic area under the curve = 0.95), and improves classification performance when differentiating microbubble from tissue signals (p < 0.005). NSSA-based signal classification eliminates the need for destruction of contrast, and may offer better sensitivity, specificity and the opportunity for real-time microbubble detection and classification.
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Affiliation(s)
- Elizabeth B Herbst
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA
| | - Sunil Unnikrishnan
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA
| | - Alexander L Klibanov
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - F William Mauldin
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA
| | - John A Hossack
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA.
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Yuan HX, Wang WP, Wen JX, Lin LW, Exner AA, Guan PS, Chen XJ. Dual-Targeted Microbubbles Specific to Integrin αVβ3 and Vascular Endothelial Growth Factor Receptor 2 for Ultrasonography Evaluation of Tumor Angiogenesis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1460-1467. [PMID: 29706409 DOI: 10.1016/j.ultrasmedbio.2018.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
Aggressive tumors are characterized by angiogenesis that promotes the migration and dissemination of tumor cells. Our aim was to develop a dual-targeted microbubble system for non-invasive evaluation of tumor angiogenesis in ultrasound. Avidinylated microbubbles were conjugated with biotinylated arginylglycylaspartic acid and vascular endothelial growth factor receptor 2 (VEGFR2) antibodies. Subcutaneous MHCC-97H liver carcinoma models were established. Non-targeted, αvβ3-targeted, VEGFR2-targeted and dual-targeted microbubbles was intravenously injected in series while acquiring ultrasound images of the tumor. The microbubbles were destroyed by a high-mechanical-index pulse 4 min after the injection. Peak intensity (PI) before and after the destructive pulse was recorded to compare contrast enhancement by different microbubbles. The targeting rates of the integrin-targeted, VEGFR2-targeted and dual-targeted groups were 95.02%, 96.04% and 94.23%, respectively, with no significant differences. Tumors in all groups were significantly enhanced. The time-intensity curve indicated no significant differences in arrival time, PI, area under the curve, amplitude and mean transit time. The difference in ultrasound signal intensity before and after the destructive pulse (⊿PI) for all targeted microbubble groups was significantly greater than that for the non-targeted microbubble group (all p values < 0.05), and the difference for the dual-targeted microbubble group was significantly greater than those of both mono-targeted groups (p <0.05).
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Affiliation(s)
- Hai-Xia Yuan
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China; Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China.
| | - Jie-Xian Wen
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Le-Wu Lin
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China; Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China
| | - Agata A Exner
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Pei-Shan Guan
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China; Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China
| | - Xue-Jun Chen
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China; Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China
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