ULTRA-SR Challenge: Assessment of Ultrasound Localization and TRacking Algorithms for Super-Resolution Imaging

With the widespread interest and uptake of super-resolution ultrasound (SRUS) through localization and tracking of microbubbles, also known as ultrasound localization microscopy (ULM), many localization and tracking algorithms have been developed. ULM can image many centimeters into tissue in-vivo and track microvascular flow non-invasively with sub-diffraction resolution. In a significant community effort, we organized a challenge, Ultrasound Localization and TRacking Algorithms for Super-Resolution (ULTRA-SR). The aims of this paper are threefold: to describe the challenge organization, data generation, and winning algorithms; to present the metrics and methods for evaluating challenge entrants; and to report results and findings of the evaluation. Realistic ultrasound datasets containing microvascular flow for different clinical ultrasound frequencies were simulated, using vascular flow physics, acoustic field simulation and nonlinear bubble dynamics simulation. Based on these datasets, 38 submissions from 24 research groups were evaluated against ground truth using an evaluation framework with six metrics, three for localization and three for tracking. In-vivo mouse brain and human lymph node data were also provided, and performance assessed by an expert panel. Winning algorithms are described and discussed. The publicly available data with ground truth and the defined metrics for both localization and tracking present a valuable resource for researchers to benchmark algorithms and software, identify optimized methods/software for their data, and provide insight into the current limits of the field. In conclusion, Ultra-SR challenge has provided benchmarking data and tools as well as direct comparison and insights for a number of the state-of-the art localization and tracking algorithms.

Ultrasound Localization Microscopy for Breast Cancer Imaging in Patients: Protocol Optimization and Comparison with Shear Wave Elastography

OBJECTIVE

Ultrasound localization microscopy (ULM) has gained increasing attention in recent years because of its ability to visualize blood vessels at super-resolution. The field of oncology, in particular, could benefit from detailed vascular characterization, for example, for diagnosis and therapy monitoring. This study was aimed at refining ULM for breast cancer patients by optimizing the measurement protocol, identifying translational challenges and combining ULM and shear wave elastography.

METHODS

We computed ULM images of 11 patients with breast cancer by recording contrast-enhanced ultrasound (CEUS) sequences and post-processing them in an offline pipeline. For CEUS, two different doses and injection speeds of SonoVue were applied. The best injection protocol was determined based on quantitative parameters derived from so-called occurrence maps. In addition, a suitable measurement time window was determined, also considering the occurrence of motion. ULM results were compared with shear wave elastography and histological vessel density.

RESULTS

At the higher dose and injection speed, the highest number of microbubbles, number of tracks and vessel coverage were achieved, leading to the most detailed representation of tumor vasculature. Even at the highest concentration, no significant overlay of microbubble signals occurred. Motion significantly reduced the number of usable frames, thus limiting the measurement window to 3.5 min. ULM vessel coverage was comparable to the histological vessel fraction and correlated significantly with mean tumor elasticity.

CONCLUSION

The settings for microbubble injection strongly influence ULM images, thus requiring optimized protocols for different indications. Patient and examiner motion was identified as the main translational challenge for ULM.

Comment on "So you think you can DAS? A viewpoint on delay-and-sum beamforming" [Ultrasonics 111 (2021) 106309]

It is shown herein that Perrot et al., who reviewed delay-and-sum beamforming for ultrafast ultrasound imaging in [Ultrasonics 111 (2021) 106309], misinterpreted the purpose of dynamic receive apertures. Such apertures widen with the focal length as a function of a given f-number and improve the image quality by suppressing grating lobes. Perrot et al., however, attributed erroneously the image quality improvement to suppression of measurement noise and, in doing so, proposed a suboptimal method to determine an f-number.

Frequency-Dependent F-Number Suppresses Grating Lobes and Improves the Lateral Resolution in Coherent Plane-Wave Compounding

Ultrafast imaging modes, such as coherent plane-wave compounding (CPWC), increase image uniformity and reduce grating lobe artifacts by dynamic receive apertures. The focal length and the desired aperture width maintain a given ratio, which is called the F -number. Fixed F -numbers, however, exclude useful low-frequency components from the focusing and reduce the lateral resolution. Herein, this reduction is avoided by a frequency-dependent F -number. This F -number derives from the far-field directivity pattern of a focused aperture and can be expressed in closed form. The F -number, at low frequencies, widens the aperture to improve the lateral resolution. The F -number, at high frequencies, narrows the aperture to avoid lobe overlaps and suppress grating lobes. Phantom and in vivo experiments with a Fourier-domain beamforming algorithm validated the proposed F -number in CPWC. The lateral resolution, which was measured by the median lateral full-widths at half-maximum of wires, improved by up to 46.8% and 14.9% in a wire and a tissue phantom, respectively, in comparison to fixed F -numbers. Grating lobe artifacts, which were measured by the median peak signal-to-noise ratios of wires, reduced by up to 9.9 dB in comparison to the full aperture. The proposed F -number thus outperformed F -numbers that were recently derived from the directivity of the array elements.

Ultrasound localization microscopy

Ultrasound Localization Microscopy (ULM) is an emerging technique that provides impressive super-resolved images of microvasculature, i.e., images with much better resolution than the conventional diffraction-limited ultrasound techniques and is already taking its first steps from preclinical to clinical applications. In comparison to the established perfusion or flow measurement methods, namely contrast-enhanced ultrasound (CEUS) and Doppler techniques, ULM allows imaging and flow measurements even down to the capillary level. As ULM can be realized as a post-processing method, conventional ultrasound systems can be used for. ULM relies on the localization of single microbubbles (MB) of commercial, clinically approved contrast agents. In general, these very small and strong scatterers with typical radii of 1-3 µm are imaged much larger in ultrasound images than they actually are due to the point spread function of the imaging system. However, by applying appropriate methods, these MBs can be localized with sub-pixel precision. Then, by tracking MBs over successive frames of image sequences, not only the morphology of vascular trees but also functional information such as flow velocities or directions can be obtained and visualized. In addition, quantitative parameters can be derived to describe pathological and physiological changes in the microvasculature. In this review, the general concept of ULM and conditions for its applicability to microvessel imaging are explained. Based on this, various aspects of the different processing steps for a concrete implementation are discussed. The trade-off between complete reconstruction of the microvasculature and the necessary measurement time as well as the implementation in 3D are reviewed in more detail, as they are the focus of current research. Through an overview of potential or already realized preclinical and clinical applications - pathologic angiogenesis or degeneration of vessels, physiological angiogenesis, or the general understanding of organ or tissue function - the great potential of ULM is demonstrated.

A Single-Shot Harmonic Imaging Approach Utilizing Deep Learning for Medical Ultrasound

Tissue Harmonic Imaging (THI) is an invaluable tool in clinical ultrasound owing to its enhanced contrast resolution and reduced reverberation clutter in comparison to fundamental mode imaging. However, harmonic content separation based on high pass filtering suffers from potential contrast degradation or lower axial resolution due to spectral leakage. Whereas nonlinear multi-pulse harmonic imaging schemes, such as amplitude modulation and pulse inversion, suffer from a reduced framerate and comparatively higher motion artifacts due to the necessity of at least two pulse echo acquisitions. To address this problem, we propose a deep-learning-based single-shot harmonic imaging technique capable of generating comparable image quality to pulse amplitude modulation methods, yet at a higher framerate and with fewer motion artifacts. Specifically, an asymmetric convolutional encoder-decoder structure is designed to estimate the combination of the echoes resulting from the half-amplitude transmissions using the echo produced from the full amplitude transmission as input. The echoes were acquired with the checkerboard amplitude modulation technique for training. The model was evaluated across various targets and samples to illustrate generalizability as well as the possibility and impact of transfer learning. Furthermore, for possible interpretability of the network, we investigate if the latent space of the encoder holds information on the nonlinearity parameter of the medium. We demonstrate the ability of the proposed approach to generate harmonic images with a single firing that are comparable to those from a multi-pulse acquisition.

Effects of contrast-enhanced ultrasound treatment on neoadjuvant chemotherapy in breast cancer

Purpose: Preclinical and clinical data indicate that contrast-enhanced ultrasound can enhance tumor perfusion and vessel permeability, thus, improving chemotherapy accumulation and therapeutic outcome. Therefore, we investigated the effects of high mechanical index (MI) contrast-enhanced Doppler ultrasound (CDUS) on tumor perfusion in breast cancer. Methods: In this prospective study, breast cancer patients were randomly assigned to receive either 18 minutes of high MI CDUS during chemotherapy infusion (n = 6) or chemotherapy alone (n = 5). Tumor perfusion was measured before and after at least six chemotherapy cycles using motion-model ultrasound localization microscopy. Additionally, acute effects of CDUS on vessel perfusion and chemotherapy distribution were evaluated in mice bearing triple-negative breast cancer (TNBC). Results: Morphological and functional vascular characteristics of breast cancer in patients were not significantly influenced by high MI CDUS. However, complete clinical tumor response after neoadjuvant chemotherapy was lower in high MI CDUS-treated (1/6) compared to untreated patients (4/5) and size reduction of high MI CDUS treated tumors tended to be delayed at early chemotherapy cycles. In mice with TNBC high MI CDUS decreased the perfused tumor vessel fraction (p < 0.01) without affecting carboplatin accumulation or distribution. Higher vascular immaturity and lower stromal stabilization may explain the stronger vascular response in murine than human tumors. Conclusion: High MI CDUS had no detectable effect on breast cancer vascularization in patients. In mice, the same high MI CDUS setting did not affect chemotherapy accumulation although strong effects on the tumor vasculature were detected histologically. Thus, sonopermeabilization in human breast cancers might not be effective using high MI CDUS protocols and future applications may rather focus on low MI approaches triggering microbubble oscillations instead of destruction. Furthermore, our results show that there are profound differences in the response of mouse and human tumor vasculature to high MI CDUS, which need to be further explored and considered in clinical translation.

3D sub-nanometer analysis of glucose in an aqueous solution by cryo-atom probe tomography

Atom Probe Tomography (APT) is currently a well-established technique to analyse the composition of solid materials including metals, semiconductors and ceramics with up to near-atomic resolution. Using an aqueous glucose solution, we now extended the technique to frozen solutions. While the mass signals of the common glucose fragments C_xH_y and C_xO_yH_z overlap with (H₂O)_nH from water, we achieved stoichiometrically correct values via signal deconvolution. Density functional theory (DFT) calculations were performed to investigate the stability of the detected pyranose fragments. This paper demonstrates APT’s capabilities to achieve sub-nanometre resolution in tracing whole glucose molecules in a frozen solution by using cryogenic workflows. We use a solution of defined concentration to investigate the chemical resolution capabilities as a step toward the measurement of biological molecules. Due to the evaporation of nearly intact glucose molecules, their position within the measured 3D volume of the solution can be determined with sub-nanometre resolution. Our analyses take analytical techniques to a new level, since chemical characterization methods for cryogenically-frozen solutions or biological materials are limited.

Identification of static nonlinearities by sinusoidal excitation with variable DC offsets

When identifying nonlinear systems with input-output measurements, a suitable test signal must be selected. Nonlinear systems are almost always in a cascade with linear systems, i.e., a Wiener-Hammerstein type system cascade. A suitable test signal is preferably less influenced by the linear systems and is therefore sinusoidal, if time-varying signals are required for the measurement principle, e.g., for induction or vibration measurements. Then, a sinusoidal excitation with different DC offsets is a suitable signal to analyze a static nonlinear system in a Wiener-Hammerstein type cascade by measuring the cascade output at higher harmonics of the input frequency in a steady state, e.g., by using sensitive lock-in techniques. To calculate the cascade output given the input signal or to reconstruct the static nonlinear system also given the output signal, the transfer function of the DC offset at the nonlinear system input to the higher harmonics at the nonlinear system output is required. Those transfer functions are calculated here with emphasis on the first harmonic component. The reconstruction of a static nonlinear system is demonstrated in a simple simulation scenario by inverse filtering, i.e., deconvolution, with the derived transfer function. It is pointed out that a commonly made small signal assumption to the test signal is bypassed with the deconvolution method, which can lead to more precise measurements in applications due to a higher signal-to-noise ratio at the cascade output.

Field evaporation and atom probe tomography of pure water tips

Measuring biological samples by atom probe tomography (APT) in their natural environment, i.e. aqueous solution, would take this analytical method, which is currently well established for metals, semi-conductive materials and non-metals, to a new level. It would give information about the 3D chemical structure of biological systems, which could enable unprecedented insights into biological systems and processes, such as virus protein interactions. For this future aim, we present as a first essential step the APT analysis of pure water (Milli-Q) which is the main component of biological systems. After Cryo-preparation, nanometric water tips are field evaporated with assistance by short laser pulses. The obtained data sets of several tens of millions of atoms reveal a complex evaporation behavior. Understanding the field evaporation process of water is fundamental for the measurement of more complex biological systems. For the identification of the individual signals in the mass spectrum, DFT calculations were performed to prove the stability of the detected molecules.

Assessing Vessel Reconstruction in Ultrasound Localization Microscopy by Maximum Likelihood Estimation of a Zero-Inflated Poisson Model

In clinical applications of super-resolution ultrasound imaging, it is often not possible to achieve a full reconstruction of the microvasculature within a limited measurement time. This makes the comparison of studies and quantitative parameters of vascular morphology and perfusion difficult. Therefore, saturation models were proposed to predict adequate measurement times and estimate the degree of vessel reconstruction. Here, we derive a statistical model for the microbubble counts in super-resolution voxels by a zero-inflated Poisson (ZIP) process. In this model, voxels either belong to vessels with probability P_v and count events with Poisson rate Λ , or they are empty and remain zero. In this model, P_v represents the vessel voxel density in the super-resolution image after infinite measurement time. For the parameters P_v and Λ , we give Cramér-Rao lower bounds (CRLBs) for the estimation variance and derive maximum likelihood estimators (MLEs) in a novel closed-form solution. These can be calculated with knowledge of only the counts at the end of the acquisition time. The estimators are applied to preclinical and clinical data and the MLE outperforms alternative estimators proposed before. The estimated degree of reconstruction lies between 38% and 74% after less than 90 s. Vessel probability P_v ranged from 4% to 20%. The rate parameter Λ was estimated in the range of 0.5-1.3 microbubbles/voxel. For these parameter ranges, the CRLB gives standard deviations of less than 2%, which supports that the parameters can be estimated with good precision already for limited acquisition times.

Structural phase transformations in annealed Pt/Mn/Fe trilayers

Thermally-activated phase transitions in Pt/Mn/Fe thin films were investigated by a combination of x-ray diffraction, transmission electron microscopy, secondary neutral mass spectrometry depth profiling, atomic force microscopy, and magnetic properties measurements. Post-annealing was carried out in vacuum to different temperatures up to 620 °C. Initially, at temperatures between 280 °C-450 °C first L10-MnPt is formed at the Mn/Pt interface followed by the most likely formation of metastable bcc Fe3Pt, which gets transformed by further annealing to fcc Fe3Pt and eventually to chemically ordered L12-Fe3Pt. The final product after annealing at 620 °C consists of two interesting phases, which are relevant for spintronic applications, antiferromagnetic L10-MnPt with addition of Fe and ferromagnetic L12-Fe3Pt, consistent with the initial element composition.

Super-resolution Ultrasound Imaging

The majority of exchanges of oxygen and nutrients are performed around vessels smaller than 100 μm, allowing cells to thrive everywhere in the body. Pathologies such as cancer, diabetes and arteriosclerosis can profoundly alter the microvasculature. Unfortunately, medical imaging modalities only provide indirect observation at this scale. Inspired by optical microscopy, ultrasound localization microscopy has bypassed the classic compromise between penetration and resolution in ultrasonic imaging. By localization of individual injected microbubbles and tracking of their displacement with a subwavelength resolution, vascular and velocity maps can be produced at the scale of the micrometer. Super-resolution ultrasound has also been performed through signal fluctuations with the same type of contrast agents, or through switching on and off nano-sized phase-change contrast agents. These techniques are now being applied pre-clinically and clinically for imaging of the microvasculature of the brain, kidney, skin, tumors and lymph nodes.

Modeling and Measurement of the Nonlinear Force on Nanoparticles in Magnetomotive Techniques

Magnetomotive (MM) ultrasound (US) imaging is the identification of tissue in which magnetic nanoparticle tracers are present by detecting a magnetically induced motion. Although the nanoparticles have a magnetization that depends nonlinearly on the external magnetic field, this has often been neglected, and the presence of resulting higher harmonics in the detected motion has not been reported yet. Here, the magnetization of nanoparticles in gelatin was modeled according to the Langevin theory of superparamagnetism. This nonlinear relationship has a fundamental effect on the resulting force and motion. However, the magnetic field must contain regions with a strong magnetic gradient and a low absolute magnetic field to allow the significant generation of higher harmonics in the force. To validate the model, an MM setup that has a constant magnetic gradient on one axis superimposed by a homogeneous time-varying magnetic field was used. After the magnetic characterization of the nanoparticles and calculations of the expected displacement in the setup, experiments were conducted. A laser Doppler vibrometer was used to quantify the small displacements at higher harmonics. The experimental results followed theoretical predictions. Deviations between model and experiment were attributed to a simplified mechanical modeling and temperature rise during measurements. It is concluded that in MM techniques, the nonlinear magnetization of nanoparticles must generally be considered to reconstruct quantitative parameters, to achieve optimum matching of fields and particles, or to exploit nanoparticle magnetization for tissue characterization. In addition, with the presented experimental setup, the magnetization properties of nanoparticles can be determined by MM techniques alone.

Ultrasound Imaging

Ultrasound imaging plays an important role in oncological imaging for more than five decades now. It can be applied in all tissues that are not occluded by bone or gas-filled regions. The quality of ultrasound images benefitted strongly from improved electronics and increased computational power. To the morphological imaging, several functional imaging methods were added: Flow visualization became possible by Doppler techniques and as a recent addition the elastic properties of tissues can be imaged by elastographic methods with transient shear wave imaging. In the beginning of molecular imaging, ultrasound with its contrast based on mechanical tissue properties was an unlikely candidate to play a role. However, with contrast agents consisting of micrometer-sized gas bubbles, which can be imaged with high sensitivity, ligands addressing targets in the vascular wall could be used. Because even single bubbles can be detected, this led to various ultrasound molecular imaging techniques and the ongoing development of clinical molecular contrast media. In this chapter, the basic properties of ultrasonic imaging like its contrast mechanisms and spatiotemporal resolution are discussed. The image formation and its ongoing change from line-oriented scanning to full-volume reconstructions are explained. Then, the ultrasound contrast media and imaging techniques are introduced and emerging new methods like super-resolution vascular imaging demonstrate the ongoing development in this field.

Arabidopsis species deploy distinct strategies to cope with drought stress

BACKGROUND AND AIMS

Water limitation is an important determinant of the distribution, abundance and diversity of plant species. Yet, little is known about how the response to limiting water supply changes among closely related plant species with distinct ecological preferences. Comparison of the model annual species Arabidopsis thaliana with its close perennial relatives A. lyrata and A. halleri, can help disentangle the molecular and physiological changes contributing to tolerance and avoidance mechanisms, because these species must maintain tolerance and avoidance mechanisms to increase long-term survival, but they are exposed to different levels of water stress and competition in their natural habitat.

METHODS

A dry-down experiment was conducted to mimic a period of missing precipitation. The covariation of a progressive decrease in soil water content (SWC) with various physiological and morphological plant traits across a set of representative genotypes in A. thaliana, A. lyrata and A. halleri was quantified. Transcriptome changes to soil dry-down were further monitored.

KEY RESULTS

The analysis of trait covariation demonstrates that the three species differ in the strategies they deploy to respond to drought stress. Arabidopsis thaliana showed a drought avoidance reaction but failed to survive wilting. Arabidopsis lyrata efficiently combined avoidance and tolerance mechanisms. In contrast, A. halleri showed some degree of tolerance to wilting but it did not seem to protect itself from the stress imposed by drought. Transcriptome data collected just before plant wilting and after recovery corroborated the phenotypic analysis, with A. lyrata and A. halleri showing a stronger activation of recovery- and stress-related genes, respectively.

CONCLUSIONS

The response of the three Arabidopsis species to soil dry-down reveals that they have evolved distinct strategies to face drought stress. These strategic differences are in agreement with the distinct ecological priorities of the stress-tolerant A. lyrata, the competitive A. halleri and the ruderal A. thaliana.

On the Performance of Time Domain Displacement Estimators for Magnetomotive Ultrasound Imaging

In magnetomotive (MM) ultrasound (US) imaging, magnetic nanoparticles (NPs) are excited by an external magnetic field and the tracked motion of the surrounding tissue serves as a surrogate parameter for the NP concentration. MMUS procedures exhibit weak displacement contrasts due to small forces on the NPs. Consequently, precise US-based displacement estimation is crucial in terms of a sufficiently high contrast-to-noise ratio (CNR) in MMUS imaging. Conventional MMUS detection of the NPs is based on samplewise evaluation of the phase of the in-phase and quadrature (IQ) data, where a low signal-to-noise ratio (SNR) in the data leads to strong phase noise and, thus, to an increased variance of the displacement estimate. This paper examines the performance of two time-domain displacement estimators (DEs) for MMUS imaging, which differ from conventional MMUS techniques by incorporating data from an axial segment. The normalized cross correlation (NCC) estimator and a recursive Bayesian estimator, incorporating spatial information from neighboring segments, weighted by the local SNR, are adapted for the small MMUS displacement magnitudes. Numerical simulations of MM-induced, time-harmonic bulk and Gaussian-shaped displacement profiles show that the two time-domain estimators yield a reduced estimation error compared to the phase-shift-based estimator. Phantom experiments, using our recently proposed magnetic excitation setup, show a 1.9-fold and 3.4-fold increase of the CNR in the MMUS images for the NCC and Bayes estimator compared to the conventional method, while the amount of required data is reduced by a factor of 100.

Clinical Pilot Application of Super-Resolution US Imaging in Breast Cancer

Recently, we proved in the first measurements of breast carcinomas the feasibility of super-resolution ultrasound (US) imaging by motion-model ultrasound localization microscopy in a clinical setup. Nevertheless, pronounced in-plane and out-of-plane motions, a nonoptimized microbubble injection scheme, the lower frame rate and the larger slice thickness made the processing more complex than in preclinical investigations. Here, we compare the results of state-of-the-art contrast-enhanced to super-resolution US imaging and systematically analyze the measurements to get indications for the improvement of image acquisition and processing in the future clinical studies. In this regard, the application of a saturation model to the reconstructed vessels is shown to be a valuable tool not only to estimate the measurement times necessary to adequately reconstruct the microvasculature but also for the validation of the measurements. The parameters from this model can also serve to optimize contrast agent concentration and injection protocols. Finally, for the measurements of well-perfused tumors, we observed between 28% and 50% filling for 90-s examination times.

[Perforation as a delayed complication after endoscopic full-thickness resection in a recurrent adenoma of the sigmoid]

The endoscopic full-thickness resection (EFTR) is established in ablation of recurrent colorectal adenomas, which cannot be removed by endoscopic resection in cases of fibrosis. The EFTR can be applied with low risk, in one step, with the use of special devices, such as the full-thickness resection device (FTRD^®). The main risks described in literature are bleeding and perforations. The mentioned perforations were explained by previous defects of the device system or patient-related predisposed parameters for perforation.We report the case of a 55-year old woman who underwent an endoscopic full-thickness resection with the FTRD^® due to a recurrent adenoma with high-grade intraepithelial neoplasm in the sigmoid. After primary uncomplicated development, she presented with a secondary perforation with purulent peritonitis seven days after intervention, so a sigmoid-resection was necessary. There were no signs of defects with the FTRD^® system or patient-related predisposed parameters, which prefer a perforation.Our case-report demonstrates the necessity for clinical follow up, after primary uncomplicated endoscopic full-thickness resection, to recognize delayed complications.

Ionic conductivity of melt-frozen LiBH4 films

The fast Li conductivity of LiBH₄ envisages its use in all-solid-state batteries. Powders are commonly applied. But here, we study the formation of dense micrometer films by melting, spinning and subsequent solidifying. Characterized by electron microscopy, and spectroscopy (EDX/XPS/impedance), a reversible phase transformation is confirmed as well as a maximum conductivity of 10³ S cm⁻¹.

LiBH₄ melt-frozen film as solid state electrolyte.

Plasma fatty acid profile as biomarker of coronary artery disease: a pilot study using fourth generation artificial neural networks

Many studies, focused on identifying new biomarkers for coronary artery disease (CAD) risk computation and monitoring, suggested a potential diagnostic role for fatty acids (FA). In the present study, we explored the potential diagnostic role of FA by using a data mining approach based on fourth generation artificial neural networks (ANN). Forty-one male subjects were enrolled. According to coronary angiography, 31 displayed CAD and 10 did not (non-CAD, control group). FA analysis was performed on plasma samples using a gas chromatography-mass spectrometry system and analyses were performed by an ANN method. The variables most closely related to CAD were low levels of alpha-linolenic acid, eicosapentaenoic acid, eicosatetraenoic and docosahexaenoic acids. High levels of 1,1-dimethoxyhexadecane, total dimethyl acetals and docosatetraenoic acid were related to non-CAD condition. This subset of variables, which were most closely correlated to the target diagnosis, achieved a consistent predictive rate. The average accuracy obtained was 76.5%, with 93% of sensitivity and 60% of specificity. The area under the ROC curve was equal to 0.79. In conclusion, our study highlighted the association between different plasma FA species, CAD and non-CAD conditions. The specific subset of variables could be of interest as a new diagnostic tool for CAD management.

Motion model ultrasound localization microscopy for preclinical and clinical multiparametric tumor characterization

Super-resolution imaging methods promote tissue characterization beyond the spatial resolution limits of the devices and bridge the gap between histopathological analysis and non-invasive imaging. Here, we introduce motion model ultrasound localization microscopy (mULM) as an easily applicable and robust new tool to morphologically and functionally characterize fine vascular networks in tumors at super-resolution. In tumor-bearing mice and for the first time in patients, we demonstrate that within less than 1 min scan time mULM can be realized using conventional preclinical and clinical ultrasound devices. In this context, next to highly detailed images of tumor microvascularization and the reliable quantification of relative blood volume and perfusion, mULM provides multiple new functional and morphological parameters that discriminate tumors with different vascular phenotypes. Furthermore, our initial patient data indicate that mULM can be applied in a clinical ultrasound setting opening avenues for the multiparametric characterization of tumors and the assessment of therapy response.

Unilateral deep brain stimulation suppresses alpha and beta oscillations in sensorimotor cortices

Deep brain stimulation (DBS) is an established therapy to treat motor symptoms in movement disorders such as Parkinson's disease (PD). The mechanisms leading to the high therapeutic effectiveness of DBS are poorly understood so far, but modulation of oscillatory activity is likely to play an important role. Thus, investigating the effect of DBS on cortical oscillatory activity can help clarifying the neurophysiological mechanisms of DBS. Here, we aimed at scrutinizing changes of cortical oscillatory activity by DBS at different frequencies using magnetoencephalography (MEG). MEG data from 17 PD patients were acquired during DBS of the subthalamic nucleus (STN) the day after electrode implantation and before implanting the pulse generator. We stimulated the STN unilaterally at two different stimulation frequencies, 130 Hz and 340 Hz using an external stimulator. Data from six patients had to be discarded due to strong artefacts and two other datasets were excluded since these patients were not able to finalize the paradigm. After DBS artefact removal, power spectral density (PSD) values of MEG were calculated for each individual patient and averaged over the group. DBS at both 130 Hz and 340 Hz led to a widespread suppression of cortical alpha/beta band activity (8-22 Hz) specifically over bilateral sensorimotor cortices. No significant differences were observed between the two stimulation frequencies. Our finding of a widespread suppression of cortical alpha/beta band activity is particularly interesting as PD is associated with pathologically increased levels of beta band activity in the basal ganglia-thalamo-cortical circuit. Therefore, suppression of such oscillatory activity might be an essential effect of DBS for relieving motor symptoms in PD and can be achieved at different stimulation frequencies above 100 Hz.

Expression of the sodium iodide symporter in differentiated thyroid cancer

Aim: Molecular analysis of the expression of the sodium iodide symporter (NIS) in 32 patients with differentiated thyroid cancer (DTC) and correlation with scintigraphic findings (131I,123I) in 19 (59.4%) of them. Patients, methods: NIS expression of 27 primary tumours, 13 lymphnodes and 18 distant metastases was determined by immunostaining using a murine monoclonal anti-NIS-antibody. NIS expression and radionuclide uptake of metastases were analysed by a semiquantitative visual score. Patients were divided into two subgroups: Group 1 (n = 8 patients): indirect correlation of radioiodine uptake (RIU) of subsequent metastases with NIS expression of 7 primary tumours and 3 metastases; Group 2 (n=11 patients): direct correlation of radionuclide uptake with NIS expression of 19 metastases which were excised after imaging. Results: 49 of 58 specimens (84.5%) were NIS-positive. A preserved NIS-expression was found in 12 primary tumours and 8 of 10 (80%) synchrone and 6 of 7 (85.7%) metachrone metastases. Group 1 revealed a 100% positive predictive value (PPV) of a preserved NIS expression in the primary tumour regarding radioiodine uptake in metastases while a lack of NIS expression in the primary tumor did not reliable predict a loss of the metastases’ ability to concentrate radioiodine. In group 2, only 11 of 19 (57.9%) specimens showed a concordant NIS expression and RIU whereas in the remaining 8 cases without visible RIU NIS expression was still present. Conclusions: NIS expression of the primary tumour and metastases in DTC is usually well preserved. We found a positive correlation between NIS expression of the primary and metastatic tissue but could not identify such well correspondence between NIS expression and the RIU of subsequent metastases.

Mildly oxidized HDL decrease agonist-induced platelet aggregation and release of pro-coagulant platelet extracellular vesicles

Stored platelet concentrates (PLCs) for therapeutic purpose, develop a platelet storage lesion (PSL), characterized by impaired platelet (PLT) viability and function, platelet extracellular vesicle (PL-EV) release and profound lipidomic changes. Whereas oxidized low-density lipoprotein (oxLDL) activates PLTs and promotes atherosclerosis, effects linked to oxidized high-density lipoprotein (oxHDL) are poorly characterized. PLCs from blood donors were treated with native (nHDL) or mildly oxidized HDL (moxHDL) for 5days under blood banking conditions. Flow cytometry, nanoparticle tracking analysis (NTA), aggregometry, immunoblot analysis and mass spectrometry were carried out to analyze PL-EV and platelet exosomes (PL-EX) release, PLT aggregation, protein expression, and PLT and plasma lipid composition. In comparison to total nHDL, moxHDL significantly decreased PL-EV release by -36% after 5days of PLT storage and partially reversed agonist-induced PLT aggregation. PL-EV release positively correlated with PLT aggregation. MoxHDL improved PLT membrane lipid homeostasis through enhanced uptake of lysophospholipids and their remodeling to corresponding phospholipid species. This also appeared for sphingomyelin (SM) and d18:0/d18:1 sphingosine-1-phosphate (S1P) at the expense of ceramide (Cer) and hexosylceramide (HexCer) leading to reduced Cer/S1P ratio as PLT-viability indicator. This membrane remodeling was associated with increased content of CD36 and maturation of scavenger receptor-B1 (SR-B1) protein in secreted PL-EVs. MoxHDL, more potently than nHDL, improves PLT-membrane lipid homeostasis, partially antagonizes PL-EV release and agonist-induced PLT aggregation. Altogether, this may be the result of more efficient phospho- and sphingolipid remodeling mediated by CD36 and SR-B1 in the absence of ABCA1 on PLTs. As in vitro supplement in PLCs, moxHDL has the potential to improve PLC quality and to prolong storage.

Low-Dose Molecular Ultrasound Imaging with E-Selectin-Targeted PBCA Microbubbles

PURPOSE

Our objective was to determine the lowest diagnostically effective dose for E-selectin-targeted poly n-butyl cyanoacrylate (PBCA)-shelled microbubbles and to apply it to monitor antiangiogenic therapy effects.

PROCEDURES

PBCA-shelled microbubbles (MBs) coupled to an E-selectin-specific peptide were applied in mice carrying MLS or A431 carcinoma xenografts scaling down the MB dosage to the lowest level where binding could be examined with a 18-MHz small animal ultrasound transducer. Differences in E-selectin expression in the two carcinoma xenografts were confirmed by enzyme-linked immunosorbent assay (ELISA). In addition, MLS tumor-bearing mice under antiangiogenic therapy were monitored using E-selectin-targeted MBs at the lowest applicable dose. Therapy effects on tumor vascularization were verified by immunohistological analyses.

RESULTS

The minimally required dosage was 7 × 10(7) MBs/kg body weight. This dosage was sufficient to enable E-selectin detection in high E-selectin-expressing MLS tumors, while low E-selectin-expressing A431 tumors required almost 2.5-fold higher doses. At the dose of 7 × 10(7) MBs/kg body weight, a decrease in E-selectin MB binding under antiangiogenic therapy could be assessed (being significant after 3 days of treatment; p < 0.0001), which was in line with the significant drop in E-selectin-positive area fractions that was found histologically (p < 0.05).

CONCLUSIONS

Molecular ultrasound imaging with our E-selectin-targeted MB and therapy monitoring was possible down to a dose of 7 × 10(7) MBs/kg body weight (equates to 66 μg PBCA/kg and 4.6 mg PBCA/70 kg). Improvements in choice of targets, MB composition, and other MB detection methods may improve sensitivity and lead to reliable detection results of clinically transferrable MBs at even lower dosage levels.

Comparative lipidomic analysis of synovial fluid in human and canine osteoarthritis

OBJECTIVE

The lipid profile of synovial fluid (SF) is related to the health status of joints. The early stages of human osteoarthritis (OA) are poorly understood, which larger animals are expected to be able to model closely. This study examined whether the canine groove model of OA represents early OA in humans based on the changes in the lipid species profile in SF. Furthermore, the SF lipidomes of humans and dogs were compared to determine how closely canine lipid species profiles reflect the human lipidome.

METHODS

Lipids were extracted from cell- and cellular debris-free knee SF from nine donors with healthy joints, 17 patients with early and 13 patients with late osteoarthritic changes, and nine dogs with knee OA and healthy contralateral joints. Lipid species were quantified by electrospray ionization tandem mass spectrometry (ESI-MS/MS).

RESULTS

Compared with control canine SF most lipid species were elevated in canine OA SF. Moreover, the lipid species profiles in the canine OA model resembled early OA profiles in humans. The SF lipidomes between dog and human were generally similar, with differences in certain lipid species in the phosphatidylcholine (PC), lysophosphatidylcholine (LPC) and sphingomyelin (SM) classes.

CONCLUSIONS

Our lipidomic analysis demonstrates that SF in the canine OA model closely mimics the early osteoarthritic changes that occur in humans. Further, the canine SF lipidome often reflects normal human lipid metabolism.

Photoacoustic clutter reduction by inversion of a linear scatter model using plane wave ultrasound measurements

Photoacoustic imaging aims to visualize light absorption properties of biological tissue by receiving a sound wave that is generated inside the observed object as a result of the photoacoustic effect. In clinical applications, the strong light absorption in human skin is a major problem. When high amplitude photoacoustic waves that originate from skin absorption propagate into the tissue, they are reflected back by acoustical scatterers and the reflections contribute to the received signal. The artifacts associated with these reflected waves are referred to as clutter or skin echo and limit the applicability of photoacoustic imaging for medical applications severely. This study seeks to exploit the acoustic tissue information gained by plane wave ultrasound measurements with a linear array in order to correct for reflections in the photoacoustic image. By deriving a theory for clutter waves in k-space and a matching inversion approach, photoacoustic measurements compensated for clutter are shown to be recovered.

Epicardial adipocyte hypertrophy: Association with M1-polarization and toll-like receptor pathways in coronary artery disease patients

BACKGROUND AND AIMS

In coronary artery disease (CAD) epicardial adipose tissue (EAT) shows an elevated inflammatory infiltrate. Toll-like receptors (TLRs) are important mediators of adipose tissue inflammation and they are able to recognize endogenous products released by damaged cells. Because adipocyte death may be driven by hypertrophy, our aim was to investigate in CAD and non-CAD patients the association between EAT adipocyte size, macrophage infiltration/polarization and TLR-2 and TLR-4 expression.

METHODS AND RESULTS

EAT biopsies were collected from CAD and non-CAD patients. The adipocyte size was determined by morphometric analysis. Microarray technology was used for gene expression analysis; macrophage phenotype and TLRs expression were analyzed by immunofluorescence and immunohistochemical techniques. Inflammatory mediator levels were determined by immunoassays. EAT adipocytes were larger in CAD than non-CAD patients and do not express perilipin A, a marker of lipid droplet integrity. In CAD, EAT is more infiltrated by CD68-positive cells which are polarized toward an M1 state (CD11c positive) and presents an increased pro-inflammatory profile. Both TLR-2 and TLR-4 expression is higher in EAT from CAD and observed on all the CD68-positive cells.

CONCLUSIONS

Our findings suggested that EAT hypertrophy in CAD promotes adipocyte degeneration and drives local inflammation through increased infiltration of macrophages which are mainly polarized towards an M1 state and express both TLR-2 and TLR-4.

Detection and Tracking of Multiple Microbubbles in Ultrasound B-Mode Images

The imaging of microvessels and the quantification of their blood flow is of particular interest in the characterization of tumor vasculature. The imaging resolution (50-200 μm) of high-frequency ultrasound (US) (20-50 MHz) is not sufficient to image microvessels (~10 μm) and Doppler sensitivity is not high enough to measure capillary blood flow (~1 mm/s). For imaging of blood flow in microvessels, our approach is to detect single microbubbles (MBs), track them over several frames, and to estimate their velocity. First, positions of MBs will be detected by separating B-mode frames in a moving foreground and a static background. For the crucial task of association of these positions to tracks, we implemented a modified Markov chain Monte Carlo data association (MCMCDA) algorithm, which can handle a high number of MBs. False alarms, the detection, initiation, and termination of MBs tracks are incorporated in the underlying model. To test the performance of algorithms, a US imaging simulation of a vessel tree with flowing MBs was set up (resolution 148 μm). The trajectories and flow velocity in the vessels with a lateral distance of 100 μm were reconstructed with super-resolution. In a phantom experiment, a suspension of MBs was pumped through a tube (diameter 0.4 mm) at speeds of 2.2, 4.2, 6.3, and 10.5 mm/s and was imaged with a Vevo2100 system (Visualsonics). Estimated mean speeds of the MBs were 2.1, 4.7, 7, and 10.5 mm/s. To demonstrate the applicability for in vivo measurements, a tumor xenograft-bearing mouse was imaged by this approach. The tumor vasculature was visualized with higher resolution than in a maximum intensity persistence image and the velocity values were in the expected range 0-1 mm/s.

Low-Energy Ultrasound Treatment Improves Regional Tumor Vessel Infarction by Retargeted Tissue Factor

OBJECTIVES

To enhance the regional antitumor activity of the vascular-targeting agent truncated tissue factor (tTF)-NGR by combining the therapy with low-energy ultrasound (US) treatment.

METHODS

For the in vitro US exposure of human umbilical vein endothelial cells (HUVECs), cells were put in the focus of a US transducer. For analysis of the US-induced phosphatidylserine (PS) surface concentration on HUVECs, flow cytometry was used. To demonstrate the differences in the procoagulatory efficacy of TF-derivative tTF-NGR on binding to HUVECs with a low versus high surface concentration of PS, we performed factor X activation assays. For low-energy US pretreatment, HT1080 fibrosarcoma xenotransplant-bearing nude mice were treated by tumor-regional US-mediated stimulation (ie, destruction) of microbubbles. The therapy cohorts received the tumor vessel-infarcting tTF-NGR protein with or without US pretreatment (5 minutes after US stimulation via intraperitoneal injection on 3 consecutive days).

RESULTS

Combination therapy experiments with xenotransplant-bearing nude mice significantly increased the antitumor activity of tTF-NGR by regional low-energy US destruction of vascular microbubbles in tumor vessels shortly before application of tTF-NGR (P < .05). Mechanistic studies proved the upregulation of anionic PS on the outer leaflet of the lipid bilayer of endothelial cell membranes by low-energy US and a consecutive higher potential of these preapoptotic endothelial cells to activate coagulation via tTF-NGR and coagulation factor X as being a basis for this synergistic activity.

CONCLUSIONS

Combining retargeted tTF to tumor vessels with proapoptotic stimuli for the tumor vascular endothelium increases the antitumor effects of tumor vascular infarction. Ultrasound treatment may thus be useful in this respect for regional tumor therapy.

Epicardial adipose tissue inflammation is related to vitamin D deficiency in patients affected by coronary artery disease

BACKGROUND AND AIMS

Alterations in epicardial adipose tissue (EAT) biology (i.e. increased fat thickness and inflammation) have been described in coronary artery disease (CAD) patients. In addition to its classic role in the regulation of calcium-phosphate homeostasis, vitamin D may exert immune-regulatory and anti-inflammatory effects. Whether EAT inflammation may be linked to vitamin D deficiency is still unknown. In the present study we evaluated plasma 25-hydroxycholecalciferol (25OHD) level in CAD patients and its relationship with EAT ability to locally metabolize vitamin D, EAT expression of inflammation-related molecules and EAT thickness.

METHODS AND RESULTS

Plasma 25OHD level was quantified by an immunoluminometric assay. EAT expression of inflammation-related molecules (MCP-1, PTX3, TNFα, IL-6, adiponectin), vitamin D receptor (VDR), CYP27B1 (25OHD-activating enzyme) and CYP24A1 (1,25-dihydroxycholecalciferol-metabolizing enzyme) was performed by microarray. EAT thickness was quantified by echocardiography. Median plasma 25OHD level was 10.85 ng/mL and 83% of CAD patients displayed 25OHD level below 20 ng/mL. At decreasing plasma 25OHD concentration, we observed a down-regulation in CYP27B1 and CYP24A1 level and an increased expression of VDR and pro-inflammatory cytokines (MCP-1, PTX3, TNFα, IL-6) at EAT level. No correlation was observed between plasma 25OHD level and EAT thickness.

CONCLUSION

Our data suggest an increased activation of inflammatory pathways at EAT level possibly related to systemic and local vitamin D deficiency in CAD patients. Whether maintaining an optimal vitamin D status may be helpful to reduce EAT inflammation and to prevent CAD and its progression needs further investigation.

Gradient Spin Echo (GraSE) imaging for fast myocardial T2 mapping

BACKGROUND

Quantitative Cardiovascular Magnetic Resonance (CMR) techniques have gained high interest in CMR research. Myocardial T2 mapping is thought to be helpful in diagnosis of acute myocardial conditions associated with myocardial edema. In this study we aimed to establish a technique for myocardial T2 mapping based on gradient-spin-echo (GraSE) imaging.

METHODS

The local ethics committee approved this prospective study. Written informed consent was obtained from all subjects prior to CMR. A modified GraSE sequence allowing for myocardial T2 mapping in a single breath-hold per slice using ECG-triggered acquisition of a black blood multi-echo series was developed at 1.5 Tesla. Myocardial T2 relaxation time (T2-RT) was determined by maximum likelihood estimation from magnitude phased-array multi-echo data. Four GraSE sequence variants with varying number of acquired echoes and resolution were evaluated in-vitro and in 20 healthy volunteers. Inter-study reproducibility was assessed in a subset of five volunteers. The sequence with the best overall performance was further evaluated by assessment of intra- and inter-observer agreement in all volunteers, and then implemented into the clinical CMR protocol of five patients with acute myocardial injury (myocarditis, takotsubo cardiomyopathy and myocardial infarction).

RESULTS

In-vitro studies revealed the need for well defined sequence settings to obtain accurate T2-RT measurements with GraSE. An optimized 6-echo GraSE sequence yielded an excellent agreement with the gold standard Carr-Purcell-Meiboom-Gill sequence. Global myocardial T2 relaxation times in healthy volunteers was 52.2 ± 2.0 ms (mean ± standard deviation). Mean difference between repeated examinations (n = 5) was -0.02 ms with 95% limits of agreement (LoA) of [-4.7; 4.7] ms. Intra-reader and inter-reader agreement was excellent with mean differences of -0.1 ms, 95% LoA = [-1.3; 1.2] ms and 0.1 ms, 95% LoA = [-1.5; 1.6] ms, respectively (n = 20). In patients with acute myocardial injury global myocardial T2-RTs were prolonged (mean: 61.3 ± 6.7 ms).

CONCLUSION

Using an optimized GraSE sequence CMR allows for robust, reliable, fast myocardial T2 mapping and quantitative tissue characterization. Clinically, the GraSE-based T2-mapping has the potential to complement qualitative CMR in patients with acute myocardial injuries.

Optimized SNR simultaneous multispectral photoacoustic imaging with laser diodes

Multispectral photoacoustic laser diode systems have multiple wavelengths available simultaneously. In addition to multispectral imaging, this can be exploited to increase the signal to noise ratio (SNR) by combining these wavelengths to form a combined image, but at the loss of spectral information. Here, a novel signal processing concept is introduced, which optimizes the SNR in the reconstructions of single wavelength data from combined acquisitions while simultaneously permitting to obtain a higher SNR fused image from the same data. The concept is derived for an arbitrary number of wavelengths; it is also applicable at low pulse repetition frequencies. The concept is applied in an experiment using two wavelengths, verifying the theoretical results.

Ultrastructure of skin from Refsum disease with emphasis on epidermal lamellar bodies and stratum corneum barrier lipid organization

Classic Refsum disease (RD) is a rare, autosomal recessively-inherited disorder of peroxisome metabolism due to a defect in the initial step in the alpha oxidation of phytanic acid (PA), a C16 saturated fatty acid with four methyl side groups, which accumulates in plasma and lipid enriched tissues (please see van den Brink and Wanders, Cell Mol Life Sci 63:1752-1765, 2006). It has been proposed that the disease complex in RD is in part due to the high affinity of phytanic acid for retinoid X receptors and peroxisome proliferator-activated receptors. Structurally, epidermal hyperplasia, increased numbers of cornified cell layers, presence of cells with lipid droplets in stratum basale and reduction of granular layer to a single layer have been reported by Blanchet-Bardon et al. (The ichthyoses, SP Medical & Scientific Books, New York, pp 65-69, 1978). However, lamellar body (LB) density and secretion were reportedly normal. We recently examined biopsies from four unrelated patients, using both OsO4 and RuO4 post-fixation to evaluate the barrier lipid structural organization. Although lamellar body density appeared normal, individual organelles often had distorted shape, or had non-lamellar domains interspersed with lamellar structures. Some of the organelles seemed to lack lamellar contents altogether, showing instead uniformly electron-dense contents. In addition, we also observed mitochondrial abnormalities in the nucleated epidermis. Stratum granulosum-stratum corneum junctions also showed co-existence of non-lamellar and lamellar domains, indicative of lipid phase separation. Also, partial detachment or complete absence of corneocyte lipid envelopes (CLE) was seen in the stratum corneum of all RD patients. In conclusion, abnormal LB contents, resulting in defective lamellar bilayers, as well as reduced CLEs, likely lead to impaired barrier function in RD.

Spinodal Decomposition in a Polystyren/ Cyclohexane Solution of Critical Composition

Results of experiments are reported demonstrating spinoidal decomposition in a critical mixture of polystyrene and cyclohexane. If time and length are properly scaled using data obtained from static and dynamic light scattering exper­ iments, the time evolution of the “spinodal ring” is repre­sented to a good approximation by an empirical equation proposed by Snyder and Meakin which describes spinodal decomposition for various types of systems.