Biodegradable nanoparticles demonstrated significant enhancement capability in preclinical evaluations of the particles' potential to perform targeted imaging by ultrasound.

Acoustic intensity increased significantly compared with controls when nanoparticle-targeted breast cancer cells were injected into a mouse liver, Peng-Fei Zhang, Ph.D., of Ohio State University in Columbus, reported.

Injection of the biodegradable nanoparticles into a breast tumor also resulted in significant enhancement on ultrasound.
Collectively, the studies suggested that the "polylactic acid nanoparticles may be potential agents for targeted imaging by diagnostic ultrasound," Dr. Zhang and colleagues concluded.

Nanoparticles have a prolonged circulation half-life, and because of their small size, they can easily cross into extravascular spaces. The characteristics suggest potential for use in ultrasonic imaging of cellular and matrix targets, the investigators said.
The targeted enhancement of biodegradable nanoparticles made from polylactic acid (PLA) has been demonstrated in vitro using high-frequency ultrasound. Dr. Zhang and colleagues continued the evaluation of the targeted imaging potential of the nanoparticles in studies involving diagnostic-frequency ultrasound.

Anti-Her2 monoclonal antibodies were covalently linked to the PLA nanoparticles. A suspension of nanoparticle-targeted human breast cancer cells was injected into two mouse livers.

The same volume of cancer cells treated only with phosphate buffered saline (PBS) was injected into two other mouse livers. The acoustic intensity around the injection site was quantified before and after injection.

For the in vivo evaluation, investigators injected the modified PLA nanoparticles subcutaneously in proximity to a tumor in a neu transgenic mouse. The acoustic intensity in the tumor and the relative acoustic intensity of the tumor to the skin above the tumor were quantified over time. All images were acquired by the same ultrasound machine with a 14 MHz probe.
Results in vitro showed the acoustic intensity within the injection site increased by 1.61 and 2.36 times after injection of tumor cells incubated with targeted PLA nanoparticles.

In contrast, the intensity decreased or remained unchanged in the two liver samples injected with PBS-treated cancer cells. In vivo results showed enhancement of the breast tumor following injection of the targeted nanoparticles, reaching maximal absolute and relative acoustic intensity at 30 and 15, respectively, after injection. Enhancement persisted for more than 40 minutes. No adverse effects were observed in the animals.

View the article online.

Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter.

 

Three-dimensional power Doppler ultrasound (3D PD-US) aids in more objective and reliable evaluation of the endometrial and subendometrial blood flow compared to the conventional Doppler study. However, there are contradictory findings regarding the role of this non-invasive technique as a predictor of ART outcome.

In a recent prospective study published in Fertility and Sterility, researchers have provided new evidence supporting the prognostic value of endometrial blood flow parameters, determined using 3D PD-US, in predicting success after Intra Uterine Insemination (IUI).

Ari Kim and colleagues from the Department of Obstetrics and Gynecology and Fertility Center, CHA University, South Korea, evaluated the efficacy of endometrial and subendometrial blood flow parameters determined with 3D PD-US, in predicting pregnancy following IUI. The study involved 106 women who underwent ovulation induction and IUI, and all the subjects were subjected to color Doppler ultrasound and 3D PD-US on the day of IUI.

The main outcomes measured included resistance index (RI), pulsatility index (PI), and systolic/diastolic (S/D) ratio of the uterine artery. Additionally, flow index (FI), vascularization index (VI), and vascularization flow index (VFI), in both endometrial and subendometrial regions were determined. The researchers also evaluated these measurements with regard to the outcome of IUI (pregnancy vs. non-pregnancy).

The study results showed that the endometrial scores of VI, FI, and VFI were greater in the pregnant subjects compared to the non-pregnant group. However, the two groups did not exhibit any difference in the corresponding scores of the subendometrial region, and also the PI, RI, and S/D scores of the uterine artery. Based on the findings, it was suggested that 3D PD-US may be useful in identifying neovascularization in the endometrial and subendometrial regions in IUI cycles, and also the potential of endometrial blood flow parameters in predicting pregnancy as an outcome.

Earlier, a prospective, non-randomized study conducted by Wu et al (Fertility and Sterility, 2003) analyzed endometrial receptivity based on 3D PD-US-measured endometrial volume and subendometrial blood flow. The clinical study comprised of 54 patients, below 38 years of age, undergoing their first IVF cycle. All the subjects had normal basal serum follicle stimulating hormone (FSH) levels and 3D PD-US-confirmed morphologically normal uteri. Apart from the ultrasonographic evaluation on the day of hCG administration, conception rates were also assessed.

The receiver operating characteristics curve analysis demonstrated that subendometrial VFI was a superior predictor of IVF pregnancy rate than VI, FI, or endometrial volume. Also, a VFI cutoff of >0.24 had the best prognostic value with respect to the pregnancy rate. The researchers suggested that the 3D PD-US-evaluated subendometrial blood flow, especially VFI, could serve as an ultrasound parameter for predicting IVF outcome.

The results of a more recent study by Ng et al (Reproductive Biomedicine Online, 2009) suggested that pregnancy after IVF could not be indicated by measuring endometrial and subendometrial blood flows with 3D PD-US, either on the day of hCG administration or on the embryo transfer day. Similar findings were documented with respect to the changes in endometrial and subendometrial blood flow between these two days and the treatment outcome.

Endometrial blood flow evaluation during ART has garnered a lot of research attention in the past few years since it is clear that good endometrial vascularity is essential for implantation. The endometrial receptivity is commonly assessed using ultrasound scanning, and the various ultrasound parameters used to determine endometrial receptivity during ART include the Doppler study of uterine arteries and evaluation of endometrial pattern, volume, blood flow, and thickness.

There is lack of consensus on the best time for performing ultrasound for the measurement of the endometrial receptivity during ART. Several studies have also suggested that the determination of endometrial blood flow during the follicular and early luteal phase may assist in observing the changes and differentiating the function of endometrial and subendometrial blood flows.

View the article online.

Article written by staff at ivfnewsdirect.com and adapted for the purposes of this newsletter.

 

A preprogrammed protocol can significantly improve the efficiency of breast ultrasound survey scans compared to standard scanning routines, according to research from Northwestern University Feinberg School of Medicine in Chicago.

"We found the protocol enabled the operator to focus on scanning and findings instead of annotating," said Dr. Holly Marshall. "And the protocol promoted consistency in acquiring images for interpretation." She presented the team's findings during a scientific session at the 2009 American Roentgen Ray Society (ARRS) meeting in Boston.

Based on its success in improving efficiency in obstetric and hepatic sonography, scanning with preprogrammed protocols has recently been introduced for breast survey scanning, Marshall said. In addition, results from the American College of Radiology Imaging Network (ACRIN) 6666 screening ultrasound trial have led to heightened interest in survey scanning for screening and for evaluating the extent of disease in cancer patients, she said.

"Workflow in the electronic setting is a current issue in many breast centers, as time-saving measures are needed to accommodate increased patient demand and volumes, particularly as many diagnostic evaluations have become multimodality," she said.
To investigate the usefulness of a preprogrammed protocol for breast ultrasound survey scanning, the Northwestern researchers studied a scanning template installed following a software upgrade to an iU22 ultrasound scanner (Philips Healthcare, Andover, MA).

The protocol uses a template of user-selected annotated views that follow in automated sequence. Once a view is captured, the next preannotated view will appear until the examination is completed, Marshall said. Preannotated views are programmed separately for each breast, as well as for bilateral studies, she said.

The protocol is paused for diagnostic evaluation and image capture of a finding, allowing for the usual lesion characterization techniques to be applied, for orthogonal views to be recorded, and for measurements to be taken, she said.
The researchers compared the technique with routine ultrasound scanning, in which each view was annotated manually by the operator. Thirty women were selected for or requested survey scanning; the group included those with single or multiple palpable masses, dense breasts with higher intermediate risk of breast cancer, mammographic findings, and breast pain.

Each patient was scanned twice using the iU22 scanner with either a L17-5 or L12-5 linear-array transducer, once using the preprogrammed protocol and once using routine techniques. The scanning order was randomized, and survey scans were performed by a breast-certified sonographer with 16 years of experience.

The exams included 11 unilateral exams and 19 bilateral exams. The automated protocol had an average scanning time of seven minutes, a time savings of one minute, 40 seconds, compared with the average routine scanning time of eight minutes, 40 seconds.
For unilateral exams performed using the protocol, the time to complete the study ranged from two minutes, 30 seconds, to 10 minutes. Exams performed using routine techniques ranged from three minutes, 38 seconds, to 10 minutes. In two patients, the protocol scan time was equal to or longer than the routine exam.

Bilateral studies performed using the protocol ranged from five minutes, 14 seconds, to 35 minutes, compared with a range of five minutes, four seconds, to 37 minutes for routine bilateral scanning.

In 26 of the 30 patients, the protocol scan was interrupted, which lengthened scan time. In 13 cases, the study was paused once. The exam was paused twice in six cases, three times in three cases, four times in two cases, and five times in one, according to the study team. In addition, eight pauses for multiple benign masses occurred in one case.

If the protocol was employed on 15 patients a day, the average 25-minute time savings could allow for one extra patient to be scanned per day, five additional patients per week, and 20 additional patients per month, Marshall said.
"Workflow efficiency is promoted by the protocol," she said.

In the future, the researchers believe additional protocols could be designed to further streamline workflow, such as in palpable areas of concern and recording of ultrasound-guided procedures, she said.

View the article online.

Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.

As running season quickly approaches, a number of runners may find themselves feeling pain in one of their hips following frequent training or exercise regimens. The pain is often caused by a common injury in runners called iliotibial band syndrome. Usually referred to as the IT band, the iliotibial band is a thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee.

The injury comes on very suddenly and after a run. Many will often feel a sharp pain and may not be able to straighten their leg all the way. The individual will also experience significant weakness and soreness in the entire leg, mainly centering in and around the hip, including the hamstring, glutes, and IT band. As with many running injuries, it is often hard to pinpoint what causes the pain and so it is important that diagnosis and treatment are sought immediately.

IT band syndrome is one of the leading causes of lateral knee, thigh and hip pain in runners and most orthopedists will recommend that the patient immediately begin a course of rest, anti-inflammatory medication and physical therapy. If the pain does not subside, an imaging study is prescribed, usually an MRI, to further investigate what is causing the pain and the best course of action, explained Dr. Ron Adler, Chief, Division of Ultrasound, Department of Radiology and Imaging, Hospital for Special Surgery.

“If the runner is suffering from IT band syndrome, a skillfully acquired MR examination will reveal an abnormality to the IT band as well as along the side of the hip where there is a fluid-filled sac called the trochanteric bursa, that acts as a cushion between the tendons and bones,", said Dr. Adler. A similar sac can occur in runners along the side of the knee, near the attachment site of the IT band.
The orthopedic surgeon, in consultation with the radiologist, will determine the treatment plan based on the results of the imaging study. Dr. Adler noted that one of the newest and most effective treatment options is an ultrasound-guided cortisone injection along the IT band and into the trochanteric bursa to help reduce pain or along the side of the knee.

Ultrasound-guided injections using dedicated high-resolution ultrasound equipment are very precise and allow a radiologist to target the injections directly into the areas of abnormality, thus maximizing the therapeutic outcome of the injections.
"Also, direct real-time ultrasound during the procedure allows me to visualize adjacent neurovascular structures and minimizes the risk of complications," Dr. Adler continued. The guided injection plays a very important role in recovery and will allow the runner to continue a physical therapy regimen.

Often times, runners will be back up and on their feet in about a week following the injection, but it is important to note that all patients and their outcomes will differ.
Some key things that cause IT band syndrome include:

• Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the thigh bone or femur
• Inadequate warm-up or cool-down
• Increasing distance too quickly or excessive downhill running
• In cycling, having the feet "toed-in" to an excessive angle
• Running up and down stairs

It is important that runners always warm up before a run, monitor aches and pains and consult with a sports medicine specialist when experiencing pain before, during or after a run.

View the article online.

Article written by staff at huffingtonpost.com and adapted for the purposes of this newsletter.