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Objective: Uterine abnormalities, such as leiomyomas, endometrial polyps, and adenomyosis, are often clinically associated with irregular uterine bleeding. These abnormalities can have similar B-mode characteristics but require different treatment. The objective of this study was to develop diagnostic techniques based on ultrasound strain imaging that would allow in vivo visualization and characterization of endometrial and myometrial uterine abnormalities, enabling physicians to improve diagnosis and treatment., Methods: Ultrasound strain imaging was performed on 29 uteri removed via elective hysterectomy. An ultrasound system with a linear array transducer was used to obtain radio frequency echo data during manual freehand compressions of the tissue. Radio frequency data were post-processed with a 2-dimensional block-matching algorithm to generate strain images., Results: In the uteri involved in this study, there were 19 leiomyomas, 1 case of adenomyosis, and 3 endometrial polyps observed on strain imaging. Leiomyomas appeared stiffer than the surrounding normal myometrium in strain images and were characterized by a slipping artifact at their boundary. Endometrial polyps appeared softer than the normal surrounding myometrium. The average strain contrast in small leiomyomas (<1.5 cm) compared to the myometrium was 1.75 +/- 1.14; the strain contrast was 2.50 +/- 1.15 in large leiomyomas and 0.40 +/- 0.05 in endometrial polyps. Leiomyoma strain contrast results were consistent with modulus contrast values from mechanical testing results., Conclusions: Ultrasound strain imaging can differentiate between endometrial polyps and leiomyomas. More data are necessary to validate these results and to ascertain whether other uterine abnormalities can also be differentiated.

Objective: As are the attenuation coefficient and sound speed, the backscatter coefficient is a fundamental ultrasonic property that has been used to characterize many tissues. Unfortunately, there is currently far less standardization for the ultrasonic backscatter measurement than for the other two, as evidenced by a previous American Institute of Ultrasound in Medicine (AIUM)-sponsored interlaboratory comparison of ultrasonic backscatter, attenuation, and speed measurements (J Ultrasound Med 1999; 18:615-631). To explore reasons for these disparities, the AIUM Endowment for Education and Research recently supported this second interlaboratory comparison, which extends the upper limit of the frequency range from 7 to 9 MHz., Methods: Eleven laboratories were provided with standard test objects designed and manufactured at the University of Wisconsin (Madison, WI). Each laboratory was asked to perform ultrasonic measurements of sound speed, attenuation coefficients, and backscatter coefficients. Each laboratory was blinded to the values of the ultrasonic properties of the test objects at the time the measurements were performed., Results: Eight of the 11 laboratories submitted results. The range of variation of absolute magnitude of backscatter coefficient measurements was about 2 orders of magnitude. If the results of 1 outlier laboratory are excluded, then the range is reduced to about 1 order of magnitude. Agreement regarding frequency dependence of backscatter was better than reported in the previous interlaboratory comparison. For example, when scatterers were small compared with the ultrasonic wavelength, experimental frequency-dependent backscatter coefficient data obtained by the participating laboratories were usually consistent with the expected Rayleigh scattering behavior (proportional to frequency to the fourth power)., Conclusions: Greater standardization of backscatter measurement methods is needed. Measurements of frequency dependence of backscatter are more consistent than measurements of absolute magnitude.

Objective: Current determinations of diagnostic ultrasound exposure parameters (eg, peak rarefactional pressure and pulse intensity integral) are intended to correspond to propagation through soft tissue with a propagation speed of 1540 m/s and attenuation of 0.3 dB x cm(-1) x MHz(-1). These current measurements are made in water, which has very little attenuation, and a linear derating factor is applied to approximate 0.3 dB x cm(-1) x MHz(-1) attenuation. The fact that propagation through water as well as through soft tissue involves nonlinear propagation is not directly addressed. A better way to determine exposure parameters would be to use a liquid that has the desired tissue-mimicking properties, including a value of the nonlinearity parameter B/A representative of soft tissue. To be of practical use in the laboratory, the ultrasonic properties of this liquid must remain stable and spatially uniform for many months or years without need for periodic mixing by the user., Methods: Fifty-two samples of fat-free milk that was concentrated to one third of its original volume by ultrafiltration were created. Each sample was preserved by a different method. The speed of sound, attenuation, and nonlinearity parameter B/A of each sample were periodically monitored by narrowband through-transmission techniques., Results: Six of the 52 samples remained liquid and retained acceptably stable acoustic properties over 22 months of storage at room temperature., Conclusions: Fat-free milk, concentrated via ultrafiltration and preserved in 1 of 6 different methods, has been found to be a stable tissue-mimicking liquid with acoustic properties appropriate for use in exposimetry.

In a study involving 10 different sites, independent results of measurements of ultrasonic properties on equivalent tissue-mimicking samples are reported and compared. The properties measured were propagation speed, attenuation coefficients, and backscatter coefficients. Reasonably good agreement exists for attenuation coefficients, but less satisfactory results were found for propagation speeds. As anticipated, agreement was not impressive in the case of backscatter coefficients. Results for four sites agreed rather well in both absolute values and frequency dependence, and results from other sites were lower by as much as an order of magnitude. The study is valuable for laboratories doing quantitative studies.

A liquid has been developed that mimics soft tissue in terms of propagation speed, attenuation, and nonlinearity parameter B/A. Since the slope of the attenuation coefficient is nearly constant up to at least 18 MHz and the value can be anywhere in the range 0.1 through 0.7 dB/(cm MHz), the material is ideal for assessing the effectiveness of attenuation derating of output acoustic intensities and pressures measured in water. A clinical ultrasound system was used to transmit into the tissue mimicking liquid. The pulse intensity integral and rarefactional pressure at various field locations in the tissue mimicking liquid were computed and compared to the corresponding values measured in water with attenuation derating applied. The slope of the attenuation coefficient in the tissue mimicking liquid was used for the derating. From this data it is seen that the present practice of modeling in vivo exposure using linearly derated measurements made in water is not always conservative.

Determination of a complete set of sonographic exposure parameters is desirable for any clinical ultrasound unit and is particularly important in controlled studies of biologic effects. When the exposure system is a diagnostic real-time scanner operating in autoscan mode, the determination of two of these parameters, the spatial average-temporal average (SATA) and the spatial average-pulse average (SAPA) intensities, is not straightforward because of the spatial overlap of successive propagating pulses. A method is described for determining these intensities for autoscan operation. The primary tool in the method is a digital oscilloscope, which supports pretrigger recording and configuring of the oscilloscope's memory into segments that can record rapidly occurring successive pulses, each segment recording one pulse. Results for a few commercially available real-time scanning systems are presented.

To determine what, if any, effects exposure to ultrasonic beams has on preimplantation embryos we isolated mouse blastocysts and assessed resorption rate, pregnancy rate, decidual swelling volume, and live birth rate after in vitro exposure with subsequent transfer to surrogate mothers. The blastocyst stage embryos were isolated by flushing the uteri of pregnant animals with a phosphate buffered medium. Blastocysts at a discrete stage of development were pooled and transferred to a PB1-methylcellulose medium. This medium is specifically designed to maintain the embryos in a high viscosity solution during the sonographic exposure to prevent microcavitation. After the exposure, the embryos were washed free of methylcellulose and transferred to the uteri of pseudopregnant surrogate mothers. A total of 660 blastocyst stage embryos were distributed among seven treatment groups. After exposure, the embryos were transferred to 54 surrogate mothers. A total of 199 embryos were implanted successfully for postimplantation evaluation. An additional 427 blastocysts were distributed among four treatment groups and transferred to 46 surrogate mothers to assess the effect of sonographic exposure on birth rate. The results indicate possible deleterious effects (decreased implantation rate, increased resorption rate, decreased decidual swelling volume, and increased stillbirth rate) of short ultrasonic exposures (1 min and 5 min) on mouse blastocyst function.

Lymphocyte and lymphoblastoid cells were exposed in vitro to diagnostic levels of ultrasonic beams delivered by a Hewlett-Packard CE 30001 and a GE system with a 5 MHz linear transducer for 20 sec, 1 min, 5 min, and 20 min. Temperature and cavitation effects were controlled and there were matched sham exposures. The synergistic effects of theophylline with ultrasonography also were investigated. Small increases in sister chromatid exchange levels were observed after ultrasonic exposure, but increases were so small as to be unlikely to have clinical relevance. Theophylline was found to have no effect and ultrasonography had no effect on cell viability.

An apparatus and procedure for well-controlled exposure of cells or explant mouse embryos to clinical real-time ultrasound are described. Cells or embryos to be exposed are suspended in media made sufficiently viscous through inclusion of methylcellulose that cavitation is suppressed but thermal effects remain negligible. During exposure, the scanning beam is precisely centered in a 2 mm x 20 mm slot in a 20 cm diameter agar disc containing the suspension. The high viscosity causes the cells to remain distributed uniformly throughout the exposure; this fact, along with precision beam alignment, ensures that exposure is well defined. Exposure data are acquired with a 0.6 mm diameter hydrophone.

The ability of diagnostic pulsed ultrasound to induce heritable genetic damage of the type that could result in neoplasia was assayed using BHK21/cl 13 hamster cells or normal human fibroblasts as targets. Using an exposure apparatus carefully designed to minimize beam attenuation and reflection, cavitation, and heating, cells were exposed from 20 seconds to 40 minutes either to clinical machines operating at maximum power, or to a highly focused nonclinical transducer at 2900 W/cm2, or to 200 shocks from a lithotripter. No evidence of an increase in the frequency of neoplastically transformed BHK cells or in the frequency of mutant human cells was seen over those found in matched sham-exposed controls.

A set of test samples, all containing ultrasonically equivalent tissue-mimicking material, was produced and measurements of ultrasonic speed and ultrasonic attenuation coefficients were made at seven laboratories using various techniques. The ultrasonic speed values agree well with one another, having a spread of about 0.3 per cent; thus, speed values for tissue parenchyma appearing in the literature are likely to be accurate. Values of ultrasonic attenuation coefficients agree fairly well with one another, with differences between individual values and the group mean of generally less than 20 per cent of the group mean.