Plateau iris syndrome: ultrasound biomicroscopic and histologic study.
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Aged↗
Biomedical subjects
F S Foster
Publications and source records attributed to F S Foster.
Ultrasound biomicroscopy of anterior segment structures in normal and glaucomatous eyes.
We developed a new method of imaging the anterior segment of the eye using high-frequency ultrasound that allows structural details of the angle, iris, ciliary body, zonule, and posterior chamber to be visualized and measured at microscopic resolution in living patients. We applied the term ultrasound biomicroscopy to this technique, which we used to image anterior segment structures in a series of nine normal subjects. We provide a system of definition for anterior segment measurements that will allow reproducible measurements to be performed in the future. Measurements in normal subjects provide a foundation for future studies of specific glaucoma types and facilitate comparison of normal and glaucomatous eyes. Images in several specific types of glaucoma were obtained to exemplify the potential of this technique.
Anterior Eye Segment↗
Ultrasound biomicroscopy in plateau iris syndrome.
Ultrasound biomicroscopy is a new technique that uses high-frequency ultrasound (50 to 100 MHz) to produce images of the entire anterior segment at high resolution (20 to 50 microns). The iridocorneal angle, iris, ciliary body, and posterior chamber can be imaged in detail and the dimensions and anatomic relationships of these structures determined. Plateau iris syndrome is a condition in which the angle remains appositionally closed or occludable after iridectomy for angle-closure glaucoma. How the iris remains in a position that allows it to occlude the angle has been uncertain. We performed ultrasound biomicroscopy eye examinations on eight patients with clinically diagnosed plateau iris syndrome. In all the patients, ciliary processes were situated anteriorly compared to the position in normal subjects and in patients with angle closure caused by pupillary block. The ciliary processes provide structural support beneath the peripheral iris, preventing the iris root from falling away from the trabecular meshwork after iridectomy.
Anterior Eye Segment↗
In vitro high resolution intravascular imaging in muscular and elastic arteries.
High resolution (125-microns lateral, 55-microns axial) images of 16 muscular (femoral) and 15 elastic (common carotid) human arteries were made in vitro with use of a prototype 45-MHz intravascular imaging system. Four distinct regions of scattering, excluding plaque, were identified in the ultrasound images corresponding histologically to the adventitia, media, thickened intima and elastic laminae, both internal and external. Arterial samples imaged under pressure and in a collapsed state underwent dimensional changes but exhibited similar levels of backscatter amplitude. All the elastic arteries displayed a prominent echogenic media, whereas all the muscular arteries displayed an echolucent media. Scattering from the internal elastic lamina in muscular arteries provided an excellent landmark for defining the location and extent of intimal thickening or plaque. In elastic arteries the internal elastic lamina could not be distinguished from the echogenic media; consequently, the boundary between the media and intimal layer was indistinct. Differences in the relative concentration and organization of collagen and elastin were found to provide a consistent explanation for the differences in scattering that were observed between individual layers within an artery as well as between muscular and elastic arteries.
Arteriosclerosis↗
Ultrasound biomicroscopy of anterior segment tumors.
BACKGROUND: Ultrasound biomicroscopy is a new method of imaging the anterior segment of the eye at microscopic resolution using high frequency ultrasound. METHODS: A prospective study was performed to evaluate the use of ultrasound biomicroscopy in imaging anterior segment tumors. Forty-five patients underwent clinical examination followed by slit-lamp photography, anterior segment B-scan ultrasonography, and ultrasound biomicroscopy according to an established protocol. RESULTS: All lesions were clearly imaged by ultrasound biomicroscopy, while only 17 were detectable by conventional B-scan ultrasound. Ultrasound biomicroscopy allowed precise measurement and visualization of subsurface features in small tumors. Differentiation between solid and cystic lesions was easily achieved. The margins of ciliary body tumors could be more accurately defined. Histopathologic correlation was possible in four cases managed surgically. Ultrasound biomicroscopy images compared favorably with low-power microscopy. No complications were encountered. CONCLUSION: Ultrasound biomicroscopy proved a valuable new noninvasive technique in the evaluation of anterior segment tumors.
Anterior Eye Segment↗
Use of a high frequency ultrasound microscope to image the action of 2-nitroimidazoles in multicellular spheroids.
A system was designed to allow imaging of control and drug treated multicellular spheroids with a high frequency backscatter ultrasound microscope. It allowed imaging of individual spheroids under good growth conditions. Since little data were available on cellular toxicity of ultrasound at these high frequencies (80 MHz), studies were undertaken to evaluate effects on cell survival, using a colony forming assay. No toxicity was observed on cell monolayers subjected to pulsed ultrasound at the intensities used for imaging experiments. Spheroids were also subjected to pulsed ultrasound and no growth delay was observed when exposed spheroids were compared with mock-exposed spheroids. Imaging studies were performed and pictures of untreated spheroids were obtained in which the necrotic and viable regions are clearly distinguishable. When the hypoxic cell cytotoxin 1-methyl-2-nitroimidazole (INO2) was added to the spheroid, dramatic changes were observed in the backscatter signal. The interior viable cells of the spheroid were selectively affected. Changes in the backscatter signal were also observed when the reduction product 1-methyl-2-nitrosoimidazole (INO) was added to spheroids. With INO however, the changes were located at the periphery of the spheroid, presumably due to the high reactivity of INO which limits diffusion of the drug into the spheroid. The present work demonstrates the potential usefulness of ultrasound backscatter microscopy in following the action of selected drugs in this in vitro tumour model.
Animals↗
Accelerated gallstone dissolution in methyl tert-butyl ether by sonication. An in vitro study.
OBJECTIVES: The authors tested the effect of 195 KHz therapeutic ultrasound energy on gallstone dissolution in concert with methyl tert-butyl ether (MTBE) in vitro. METHODS: Sixteen sets of three gallstones matched for weight and appearance were selected from 16 surgically resected human gallbladders. One stone from each set was analyzed for its density pattern by computed tomography (CT) and biochemically for cholesterol content. Based on CT appearance, the stones were classified into eight noncalcified, four partially calcified, and four heavily calcified sets. The three stones were subjected to dissolution with MTBE: one with simultaneous sonication via an experimental ultrasound unit, one with manual stirring, and one acted as control without added treatment. RESULTS: Sonication reduced the dissolution time of noncalcified stones by 96% (range, 94%-98%; standard deviation [SD], 2%) relative to controls, and it was three to four times more effective than manual stirring. It was similarly effective in helping to dissolve partially calcified stones, but not heavily calcified stones. CONCLUSIONS: This study demonstrates the positive effect of sonication in accelerating gallstone dissolution with MTBE in vitro for stones without heavy calcification.
Cholelithiasis↗
Ultrasound biomicroscopy in glaucoma.
Ultrasound Biomicroscopy is a newly developed high resolution imaging method that uses high frequency ultrasound (50-100 MHz). Tissue penetration is about 4 mm. This method allows detailed observation of anterior and posterior chamber anatomy in the living eye, and is thus a useful tool in both clinical assessment of glaucoma, and research into causes of various glaucoma types.
Anterior Chamber↗
Simulation of B-scan images from two-dimensional transducer arrays: Part I--Methods and quantitative contrast measurements.
Recently, theoretical investigations of the beamforming capability of two-dimensional (2-D) transducer arrays have characterized the array parameters required to steer a symmetrically focused ultrasound beam up to 45 degrees off-axis. These investigations have also shown that the number of elements in a steered 2-D array can be dramatically reduced by using a sparse set of elements, randomly distributed throughout the aperture of the transducer. The penalty paid for the use of a sparse array is the development of a "pedestal" sidelobe in the beam profile, the amplitude of which increases as the number of elements in the array decreases. In this paper the potential of 2-D arrays for medical imaging is assessed by simulating B-scan images of spherical lesions, both cystic and scattering, embedded in a large random scattering volume. Similar contrast characteristics over a range of cyst sizes are demonstrated for a dense 2-D array and a sparse array with 1/8th the number of elements, both operating at 5 MHz. A 32nd order sparse array is shown to perform at a reduced level, producing unacceptable artifactual echoes within images of cysts. The 8th order sparse array pattern has been fabricated on a fixed-focus poly(vinylidene difluoride) transducer using photolithographic techniques. Experimental images from this transducer are used to verify some of the theoretical predictions made in this paper. Comparisons between simulated B-scan images from linear and 2-D phased arrays are presented in a companion paper.
Artifacts↗
Simulation of B-scan images from two-dimensional transducer arrays: Part II--Comparisons between linear and two-dimensional phased arrays.
Two-dimensional (2-D) arrays have been proposed as a solution to the degradation in medical ultrasound image quality occurring as a result of asymmetric focusing properties of linear phased array transducers. The 2-D phased transducer array is also capable of electronically steering the symmetrically focused ultrasound beam throughout a three-dimensional volume. In a companion paper the potential of 2-D transducer arrays for medical imaging has been investigated using simulated B-scan images. In this paper, the advantages of 2-D over linear transducer arrays is demonstrated by simulating images of spherical cysts embedded in a large scattering volume. The large elevation beamwidth in the nearfield of a 5 MHz linear phased transducer array results in a severe reduction in the image contrast measured between a 4 mm diameter cyst and the surrounding scattering media. By employing a 2-D array with symmetric focusing, the contrast between the cyst and surrounding scatterers is significantly improved. The use of additional elements in the elevation direction of a linear array is also investigated. In this case the additional elements are included only to focus, but not to steer the ultrasound beam. Using the contrast characteristics of a 4 mm diameter cyst, it is shown that relatively few elevation elements are required to significantly improve the nearfield imaging capability of the linear array.
Artifacts↗
Measurement of the ultrasonic properties of vascular tissues and blood from 35-65 MHz.
A 50 MHz ultrasound backscatter microscope has been built to measure the acoustic properties of vascular tissues and blood over the frequency range from 35-65 MHz. High resolution (45 microns) ultrasound backscatter microscope images of nine femoral and eight common carotid human artery samples were made and compared with corresponding histological sections. Individual tissue layers were selected using these images for quantitative measurement of the frequency dependent backscatter. Backscatter measurements were made in each layer of an artery at two different angles of incidence: along the axis of the artery (axial direction) and at 90 degrees to this measurement radially out from the center of the artery (radial direction). Scattering was found to be higher in elastic arteries (carotid) than in the muscular arteries (femoral). The largest difference was found in the media where the average scatter (measured in the radial direction at 50 MHz) increased from 0.002 sr-1 mm-1 in muscular arteries to 0.4 sr-1 mm-1 in elastic arteries. Large differences in scattering between measurements made in the axial and radial direction were also found. Again, the largest differences were found in the media where scattering (at 50 MHz) in carotid arteries increased from 0.003 sr-1 mm-1 measured in the axial direction to 0.4 sr-1 mm-1 measured in the radial direction. The speed of sound and attenuation in the artery wall of each sample were measured. Speed of sound measurements were found to range between 1579-1628 ms-1. The average attenuation in the artery wall increased from 4 dB mm-1 at 30 MHz to 10 dB mm-1 at 60 mHz. This is higher than the attenuation measured in blood which increased from 1.6 dB mm-1 to 5 dB mm-1 over the same frequency range. The backscatter coefficient for flowing blood was measured for flow velocities up to 36 cms-1. At flow velocities below 18 cms-1 a level of scattering of 0.0005 sr-1 mm-1 (at 50 MHz) was found. An increase in scattering of 1.6 times was measured when the flow velocity was increased to 36 cms-1. All measurements were made at 37 degrees C. The relevance of these results to clinical imaging and image interpretation is discussed.
Arteriosclerosis↗
Clinical use of ultrasound biomicroscopy.
The authors have developed a method of obtaining images of cross-sections of the intact anterior globe at microscopic resolution. High-frequency ultrasound transducers (50-100 MHz) have been developed and incorporated into a clinical B-scan device capable of producing images in the living human eye to a depth of approximately 4 mm at an axial and lateral resolution approaching 20 microns. Clinical use of this instrument is no more difficult than conventional immersion ultrasonography. The authors' results in a series of 14 clinical cases have shown that this method can provide information unavailable from any other imaging technique. Anterior segment tumors difficult to define with conventional ultrasound can be measured and the extent of invasion determined. Differentiation of tissue on the basis of internal acoustic characteristics is aided by the very fine backscatter speckle patterns at these frequencies. Pathology behind anterior segment opacities can be imaged in detail and the ability to image angle structures in cross-section allows a new quantitative method of gonioscopy. The ability to define the relationship of the iris, posterior chamber, zonules, ciliary body, and lens is potentially helpful in understanding mechanisms of glaucoma. Ocular structures can be measured with increased accuracy. Clinical ultrasound biomicroscopy (UBM) has shown significant potential as an aid in diagnoses of ocular disease.
Anterior Eye Segment↗
Clinical performance of a cone/annular array ultrasound breast scanner.
Ultrasound is a useful adjunctive imaging modality to x-ray mammography for the detection and management of breast disease. A high resolution (0.3 mm at -6 dB) transducer consisting of co-axially aligned cone and annular array transducers has been incorporated into a prototype breast imaging system. The prototype scanner had an operating frequency of 4 MHz and scanning was performed in the prone position. We hypothesized that the increased resolution of this system would lead to improved detection of smaller, nonpalpable lesions and would thus contribute to the early detection of breast cancer. Results of a four year clinical study of the prototype involving 1743 patients are reported. The overall true positive (TP) fraction for the detection of malignancy was 52.5% compared with 86.6% for x-ray mammography. Improved performance of ultrasound approaching that of mammography is demonstrated for the youngest age group (less than 34 years) and for women whose breasts are predominantly dysplastic. However, the detection of nonpalpable tumours is disappointing with a TP fraction of only 22%. Causes for the failure of the prototype breast scanner to detect early breast lesions are presented and general conclusions on the use of large aperture transducers for automated breast imaging are discussed.
Adolescent↗
Subsurface ultrasound microscopic imaging of the intact eye.
The authors have developed a method of obtaining images of cross sections of the intact eye at microscopic resolution. High-frequency ultrasound transducers (100 MHz) have been developed and incorporated into imaging devices. These devices are capable of producing images to a depth of 4 mm at an axial and lateral resolution approaching 20 microns. Resolution exceeds that of current combined A- and B-scan imaging devices by a factor of approximately 10. Microscopic images of ocular structures including Schlemm's canal, cornea, iris, ciliary muscles, and retina have been produced in eye bank eyes. These studies show the feasibility of developing an apparatus to be used in the clinical setting for examining anterior structures of the eye not visible by current techniques.
Anterior Chamber↗
Ultrasonic characterization of selected renal tissues.
Velocity, attenuation, and backscatter of ultrasound were measured in human renal tissues over a frequency range relevant to clinical imaging (3.5-7 MHz). Normal renal tissues, as well as three types of mass (angiomyolipoma, renal cell carcinoma, and oncocytoma) were studied, and comparisons made of the appearance of the tissues in clinical images to their ultrasonic and pathological properties. The results showed angiomyolipoma had high attenuation and backscatter coefficients due to acoustic impedance differences between fat and smooth muscle components of the tumour. The renal cell carcinomas were indistinguishable from normal kidney tissue, except in one case where infiltration by fatlike macrophages led to high attenuation and backscatter coefficients. This finding also supports the conclusion that fat/nonfat interfaces are a dominant scatter mechanism in renal tissues.
Adenoma↗
Development of a 12 element annular array transducer for realtime ultrasound imaging.
While the recent proliferation of ultrasound scanners based on annular array transducers has attracted widespread attention, very little published information is available on the physics, design criteria, and signal processing aspects of these instruments. In this paper, the first of a two part report, we describe the development and characterization of an annular array transducer for realtime medical imaging. Theoretical modeling of the pulsed fields of annular arrays is used to study and optimize array parameters. The factors which affect resolution and contrast in imaging--beam width, sidelobe levels, number of annuli, depth of field, and delay quantization--are discussed. A 12 element, 4.5 MHz, 30 mm design is adopted. Theoretical predictions showed excellent agreement with device measurements over a range of f-numbers (local/length/diameter) from f/1 to f/6.7 (30 to 200 mm range). Focusing to f/1 is an important advance in the state-of-the-art. A two transmit zone, dynamic receive configuration of array operation to exploit the f/1 focusing ability is proposed for realtime imaging.
Equipment Design↗
A digital annular array prototype scanner for realtime ultrasound imaging.
The use of annular array transducers in diagnostic ultrasound applications is growing. The development of this equipment raises a number of questions concerning both the role these systems will play in the clinic and how the annular array can be best implemented in an ultrasound scanner. In this paper, we will build on the results of the previous companion paper to describe the development of a 12 element 30 mm diameter 4.5 MHz laboratory prototype scanner. The mechanical probe and probe acoustics are discussed and a unique digital receive beamformer (DRB) and signal processor are described. Focusing down to an f-number (focal length/diameter) of 0.9 is demonstrated. Measured angular beamwidths of 0.62 degrees at -6 dB and 2.8 degrees at -50 dB are in good agreement with theoretical predictions. Images of phantoms and normal volunteers showed exceptional resolution with little variation in the fine speckle texture as a function of depth. The effect of the number of transmit focal zones on image quality is demonstrated.
Equipment Design↗
The design and fabrication of high frequency poly(vinylidene fluoride) transducers.
Poly(vinylidene fluoride) (PVDF) transducers are well suited for use in high frequency pulse-echo ultrasound systems because of their high bandwidth. We analyze the design parameters of PVDF transducers operating in the 100 MHz range using the KLM transducer model. The effect of backing layers, electrode configuration, transducer surface area and tuning circuits on the insertion loss and pulse-echo response of the transducers are investigated. Using this design procedure, an experimental PVDF transducer is proposed for applications in the 100 MHz range. The transducer is built into a high frequency SMA electrical connector. Insertion loss and pulse-echo response measurements are compared with theoretical predictions.
Equipment Design↗