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Emerging Applications of Contrast-enhanced Ultrasound in Trauma
Brenda E. Tester, BS, MS, Ji-Bin Liu, MD, John R. Eisenbrey, PhD, George Koenig, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 39-47.   DOI: 10.37015/AUDT.2022.220017
Abstract22)   HTML9)    PDF 23

The use of contrast-enhanced ultrasound (CEUS) has expanded over the past decade to include a variety of diagnostic and therapeutic applications. These include urgent clinical situations that require timely diagnosis and subsequent treatment. With the introduction of microbubble ultrasound contrast agents (UCAs), CEUS provides increased sensitivity and specificity over conventional ultrasound. Within the trauma setting, CEUS benefits include point of care imaging and an ability to monitor perfusion in real-time. Additionally, UCAs are non-nephrotoxic, and can be used when contrast enhanced CT is contraindicated. In this review, we discuss recent advancements of CEUS within trauma settings.

Clinical Applications of Crystal Vue Technology: A Review
Shijing Song, MD, Qingqing Wu, MD, Jingjing Wang, MD, Jinghua Li, MD, Dan Yan, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 1-6.   DOI: 10.37015/AUDT.2021.200067
Abstract112)   HTML16)    PDF 119

Three-dimensional (3D) imaging plays an important role in the construction of normal anatomy and abnormal structures. The 3D images can be obtained through computed tomography, magnetic resonance, ultrasonography (US) and other technologies with different values and prospects. 3D-US imaging has unique advantages such as being radiation-free, time-saving and cost-effective. The Crystal Vue is a novel 3D-US rending technology that provides valuable information in several obstetrical and gynaecological studies. This review focuses on the application of Crystal Vue technology in the evaluation of foetal skeleton, maxillofacial region, central nervous system, digestive tract and abnormally invasive placenta, cervical pessary, and ureteral stones.

Recent Advances in Microbubble-Augmented Cancer Therapy
Mohamed Tantawi, MD, Ji-Bin Liu, MD, John R Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 155-168.   DOI: 10.37015/AUDT.2020.200055
Abstract511)   HTML65)    PDF 467

Contrast-enhanced ultrasound (CEUS) applications in cancer management have expanded over the past two decades. Through detection of vascularization and perfusion changes, CEUS provides a potentially reliable means of early prediction of response to different cancer therapies including systemic chemotherapy and locoregional therapies. Ultrasound-induced cavitation of contrast agents has a range of effects on the surrounding microenvironment. These effects can be manipulated to sensitize the tumors to radio- and chemotherapy, as well as achieve targeted delivery through drug-loaded contrast agents. Newer forms of drug carriers are being developed with improved drug-carrying capacity and tissue penetration. This review aims at providing a synopsis of the latest developments in CEUS’ use in oncologic therapy. While the majority of work described in this review is still in the pre-clinical phases, results have been encouraging and show potential translational benefit for cancer patients in the near future.

Research Advances in Ultrasound Imaging for Tumor in Situ
Ping Wang, MD, Lihong Sun, PhD, Suhui Sun, MD, Menghong Xu, MD, Lulu Zhang, MD, Jinxia Zhang, MD, Liquan Gao, PhD, Qingfeng Chen, PhD, Xiaolong Liang, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 169-175.   DOI: 10.37015/AUDT.2020.190040
Abstract244)   HTML13)    PDF 351

Known for being highly sensitive and noninvasive, ultrasound imaging using microbubble contrast agents is widely used in the clinic. To use ultrasound to image tissue beyond the vasculature, researchers have developed strategies that include nanobubbles, ultrasound contrast agents generated in situ, and gene expression of ultrasound contrast agents in situ. All of these strategies offer the capability of targeting tumor cells, intratumoral imaging tumor cells and require just a small incision or no incision. In this review, we will first describe the application of nanobubbles acting as ultrasound contrast agents. Then, we will briefly introduce the stimuli-responsive formulations to generate ultrasound contrast agents in situ. Finally, we will provide an overview of the use of state-of-the-art of gene expression of ultrasound contrast agents in situ to monitor cellular location and function inside living organisms.

Critical Care Ultrasonography and Its Application for COVID-19
Xi Liu, MD, Yang Hai, MD, Bin Ma, MD, Weelic Chong, BA, Ji-Bin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 43-49.   DOI: 10.37015/AUDT.2020.200035
Abstract575)   HTML42)    PDF 502

Ultrasound has developed as an invaluable tool in diagnosis and proper management in the intensive care unit (ICU). Application of critical care ultrasonography is quite distinct from the routine comprehensive diagnostic ultrasound exam, because the urgent setting mandates a goal-directed approach. Performing accurate and efficient critical care ultrasound requires ultrasound providers to first understand the pathophysiology of the disease and related imaging findings, and then follow the protocols to perform a focused ultrasound exam. In the ongoing coronavirus disease 2019 (COVID-19) pandemic, ultrasound plays an essential role in diagnosing and monitoring critically ill COVID-19 patients in the ICU. Our review focuses on the basics and clinical application of critical care ultrasound in diagnosing common lung disease, COVID-19 pulmonary lesions, pediatric COVID-19, and cardiovascular dysfunction as well as its role in ECMO and interventional ultrasonography.

Teleultrasound for the COVID-19 Pandemic: A Statement from China
Xiaolong Li, MD, Lehang Guo, MD, Liping Sun, MD, PhD. Wenwen Yue, MD, Huixiong Xu, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 50-56.   DOI: 10.37015/AUDT.2020.200036
Abstract264)   HTML14)    PDF 346

The Coronavirus Disease 2019 (COVID-19) has spread rapidly throughout the world. COVID-19 is a highly contagious and potentially lethal infection, and as a result, individuals infected with it are treated in isolation units. Teleultrasound (TUS), particularly with the support of the fifth generation (5G) wireless transmission technology, can provide timely monitoring, fast clinical progress assessment, and help to guide interventional produces for patients with COVID-19 in isolation units. It can also reduce the risk of medical workers infection and save medical resources such as equipment and supplies. The purpose of this paper is to present an overview of operating procedures and ongoing planning with TUS for COVID-19 patients in China.

Lung Ultrasonography in Diagnosis and Management of Novel Coronavirus (COVID-19) Pneumonia: Pearls and Pitfalls
Heng Xue, MD, Yao Zhang, MD, Ligang Cui, MD, Jing Han, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 57-59.   DOI: 10.37015/AUDT.2020.200030
Abstract412)   HTML12)    PDF 316

The purpose of this article is to review the use of lung ultrasonography (US) in the workup of COVID-19 pneumonia. The scanning protocol, normal US appearance of lung, major US features of COVID-19 pneumonia, diagnostic performance of lung US and potential pitfalls when explaining US results are descripted and discussed. Lung US is increasingly accepted as a useful tool in the workup of COVID-19 pneumonia. Certain US imaging features allow to confirm or rule out the diagnosis for clinical management; on other hand, most US findings are nonspecific with technical limitations. Thus, it is important to recognize these drawbacks since the ignorance of potential pitfalls of lung US may lead to over diagnosis or missed diagnosis.

Progress in Imaging Diagnosis and Image-guided Puncture Biopsy of Prostate Cancer
Lixue Zhai, MD, Xiaojuan Zhang, MD, Yuxiu Gao, MD, Zhaoyan Ding, MD, Haiyang Yu, MD, Cheng Zhao, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (4): 175-181.   DOI: 10.37015/AUDT.2019.191223
Abstract353)   HTML117)    PDF 242

The current standard technique for diagnosing prostate cancer (PCa) in men at risk relies on a transrectal ultrasound (TRUS)-guided needle biopsy due to its real-time nature and simplicity to obtain systematic histological specimens of the prostate. Also several magnetic resonance imaging (MRI)-based techniques have been employed due to their high detection rate of clinically significant PCa (csPCa). MRI-TRUS fusion imaging contains both the information of MRI and TRUS images for prostate biopsies. This technique combines the strengths of these two techniques, including the superior sensitivity of MRI for targeting cancerous lesions the real time and practicality of TRUS. This review briefly introduces the development of TRUSguided biopsy, MRI-guided biopsy and MRI-TRUS fusion imaging techniques for prostate cancer.

Artificial Intelligence in Ultrasound Imaging: Current Research and Applications
Shuo Wang, BS, Ji-Bin Liu, MD, Ziyin Zhu, MD, John Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 53-61.   DOI: 10.37015/AUDT.2019.190811
Online available: 30 September 2019
Abstract1272)   HTML113)    PDF 775

Artificial intelligence (AI) is an area of computer science that emphasizes the creation of intelligent software or system based on big data information, machine learning and deep learning technologies. The rapid development of science and technology as well as internet communication has enabled AI and big data to gradually apply to many fields of health care. The modern imaging medicine is one of the first areas where AI can play an important role and applications. As cross-sectional imaging, ultrasound (US) is well suitable for AI technology to standardize imaging protocols and improve diagnostic accuracy. This article reviews current AI technology and related clinical applications in the fields of thyroid, breast and liver US.

Applications in Molecular Ultrasound Imaging: Present and Future
Vishal Thumar, MD, Ji-Bin Liu, MD, John Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 62-75.   DOI: 10.37015/AUDT.2019.190812
Online available: 30 September 2019
Abstract334)   HTML37)    PDF 395

Molecular ultrasound imaging or targeted contrast-enhanced ultrasound (CEUS) is a relatively new technique that has varied applications to augment both diagnostics and therapeutics. Ultrasound contrast agents are conjugated to ligands that bind with specific biomarkers in the areas of interest which can then be quantified using ultrasound technology. This technique has numerous clinical applications including studying pathophysiology of disease, improving diagnostic sensitivity and specificity, and improving localized drug delivery. This technology, most notably, has proven useful in numerous oncologic and cardiovascular applications. Given ultrasound’s advantages over other radiographic studies including its low cost, lack of ionizing radiation, portability, ability to provide real-time imaging, and non-invasiveness, recent investigations have expanded the utility of molecular ultrasound. In this review, we briefly review targeted ultrasound contrast agents and explore the current applications of molecular ultrasound as well as future applications based on the currently published literature.

Coronary Heart Disease Concomitant with Atherosclerotic Cerebrovascular Disease
Yumei Liu, MD, Beibei Liu, MD, MS, Boyu Li, MD, PhD, Yang Hua, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 76-80.   DOI: 10.37015/AUDT.2019.190813
Abstract281)   HTML28)    PDF 381

Cardio-cerebrovascular disease has a high rate of disability and mortality and affects a large number of people worldwide. Early prevention, accurate diagnosis and effective treatment are of great significance. This article reviews the risk factors, multimodalities of imaging diagnosis, and operational options for the atherosclerotic cardio-cerebrovascular combined disease.

CT Perfusion Imaging: A Valuable and Feasible Resolution of Pulmonary Nodules
Mai-lin Chen, MD, Ying-shi Sun, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (2): 27-34.   DOI: 10.37015/AUDT.2019.190806
Abstract223)   HTML14)    PDF 267

CT perfusion imaging, a non-invasive functional imaging method, can accurately reflect the hemodynamic changes of pulmonary nodules. It plays an important role in the diagnosis, differential diagnosis, treatment effect assessment and prognosis prediction. This article reviews the hemodynamics of pulmonary nodules, the characteristics of the blood flow of CT perfusion imaging of the pulmonary nodules, the characteristics of the CT perfusion technique of the pulmonary nodules and the status of the clinical application in the characterization of pulmonary nodules.

Advances in Modern Clinical Ultrasound
Sriharsha Gummadi, MD, John Eisenbrey, PhD, Jingzhi Li, MD, Zhaojun Li, MD, Flemming Forsberg, PhD, Andrej Lyshchik, MD, Ji-Bin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 51-63.   DOI: 10.37015/AUDT.2018.180801
Abstract852)   HTML46)    PDF 950

Advances in modern clinical ultrasound include developments in ultrasound signal processing, imaging techniques and clinical applications. Improvements in ultrasound processing include contrast and high-fidelity ultrasound imaging to expand B-mode imaging and microvascular (or microluminal) discrimination. Similarly, volumetric sonography, automated or intelligent ultrasound, and fusion imaging developed from the innate limitations of planar ultrasound, including user-operator technical dependencies and complex anatomic spatial prerequisites. Additionally, ultrasound techniques and instrumentation have evolved towards expanding access amongst clinicians and patients. To that end, portability of ultrasound systems has become paramount. This has afforded growth into the point-of-care ultrasound and remote or tele-ultrasound arenas. In parallel, advanced applications of ultrasound imaging have arisen. These include high frequency superficial sonograms to diagnose dermatologic pathologies as well as various intra-cavitary or lesional interrogations by contrast-enhanced ultrasound. Properties such as realtime definition and ease-of-access have spurned procedural and interventional applications for vascular access. This narrative review provides an overview of these advances and potential future directions of ultrasound.

Progress of In-stent Restenosis after Vertebral Artery Ostium Stenosis and Imaging Assessments
Jingzhi Li, MD, John R. Eisenbrey, PhD, Yang Hua, MD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 64-70.   DOI: 10.37015/AUDT.2018.180802
Abstract204)   HTML7)    PDF 203

Stenting has become one of the primary procedure to treat vertebral artery ostium stenosis patients. Postoperative instent restenosis (ISR) of the stenting is still one of the unsolved issues and requires systematic and further investigation. Through imaging assessments, ISR could be identified and evaluated in clinical practice and researches.

Ultrasonic Thermal Strain Imaging for Noninvasive Temperature Estimation in Tissue
Wenlong Zeng, Christopher J Krueger, Zhifei Dai, PhD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 71-81.   DOI: 10.37015/AUDT.2018.180803
Abstract509)   HTML8)    PDF 581

By virtue of advantages including no exposure to radiation and low toxicity and side effects, hyperthermia has been increasingly applied in treating cancer and other diseases. However, the challenge of continuous temperature monitoring during hyperthermia limits its further application. Currently, temperature monitoring in the clinic is primarily carried out using invasive thermometry, which is hampered by incomplete detection and pain. To overcome the obvious limitations of invasive thermometry, a variety of noninvasive thermometry methods with suitable accuracy have been explored. Among these, ultrasonic thermal strain imaging (UTSI), which exploits the temperature dependence of ultrasonic echo time shift to form thermal strain images, shows significant potential. It not only possesses the merits of ultrasonography but also displays different tissue characteristics (thermal properties of tissue and sound velocity) from other ultrasound imaging methods, so it has been investigated extensively over the past few years. This paper reviews recent advances in UTSI for noninvasive thermometry and discusses its main limitations, hoping to show the strong clinical application potential of UTSI from solid basic theory and practical research results.

Estimation of Clinical Outcomes of Irreversible Electroporation Use During Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-analysis
Tian’an Jiang, PhD, Guo Tian, MD, Liming Wu, PhD, Qiyu Zhao, PhD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 143-149.   DOI: 10.37015/AUDT.2018.180814
Abstract212)   HTML1)    PDF 292

Objective: Irreversible electroporation (IRE) is a novel nonthermal ablative technique that transmits pulsatile electricity to enable nanoscale damages of the cellular membrane and induce cellular apoptosis. To assess the safety and efficacy of IRE for locally advanced pancreatic cancer (LAPC).
Methods: Electronic databases of PubMed, Embase, Web of Science, Scopus were searched up to June 2018 for studies comparing the standardized mean differences (SMD) of size, amylase and carbohydrate antigen 19-9 (CA199) levels between pre- and post-operation for patients with pancreatic cancer. Sensitivity and stratified analyses were conducted. Quality was estimated using Newcastle-Ottawa Scale (NOS).
Results: We finally identified 10 studies including 203 participants during a mean 7.06 months of follow-up (range 1 to 29 months). The meta-analyses showed the declined tumor size at 6 months post-IRE but unchanged at 1 month, and increased amylase level at 1-day post-IRE while unchanged at the 1 week. No significant difference of CA199 level was observed between pre-IRE and post-IRE at 1 week and 1 month. No risk of publication bias was detectable, and the favorable quality and validity of all outcomes were assessed based on NOS.
Conclusions: IRE may be a relatively state-of-the-art therapy option for most patients with LAPC if imaging or explorative laparotomy indicated that LAPC was unable to be successfully resected.

The Ultrasonographic Findings of Appendiceal Diseases: Benign and Malignant
Yixuan Wang, Bei Wang, Menene NKONIKA, Hongyu Ding, Hongjun Sun
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 150-154.   DOI: 10.37015/AUDT.2018.180815
Abstract236)   HTML6)    PDF 251

The appendix is a small pouch-like sac with no fixed anatomical position, narrowing entrance to caecum predisposes to both benign and malignant obstruction in nature. In recent years, ultrasonog-raphy plays an important part in diagnosis of appendiceal diseases. This article aims to describe ul-trasonic assessment of different kinds of appendiceal diseases. We provide an overview of the liter-ature about the ultrasonographic features of appendiceal diseases.

Sonographic Features of Triple Negative Breast Cancer
Fei Li, MD, Bei Wang, MD, Hongyu Ding, MD, Hongjun Sun, MD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (1): 18-23.   DOI: 10.37015/AUDT.2018.180005
Abstract160)   HTML4)    PDF 174

Triple-negative breast cancer (TNBC) is regarded as an aggressive disease that has a poor prognosis. Preoperative diagnosis of TNBC is very important for treatment options. This article reviews the ultrasound features of TNBC so that it can be early identified.

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