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Background: Dynamic contrast‐enhanced ultrasound (DCE‐US) is highly susceptible to motion artifacts arising from patient movement, respiration, and operator handling and experience. Motion artifacts can be especially problematic in the context of perfusion quantification. In conventional 2D DCE‐US, motion correction (MC) algorithms take advantage of accompanying side‐by‐side anatomical B‐Mode images that contain time‐stable features. However, current commercial models of 3D DCE‐US do not provide side‐by‐side B‐Mode images, which makes MC challenging. Purpose: This work introduces a novel MC algorithm for 3D DCE‐US and assesses its efficacy when handling clinical data sets. Methods: In brief, the algorithm uses a pyramidal approach whereby short temporal windows consisting of three consecutive frames are created to perform local registrations, which are then registered to a master reference derived from a weighted average of all frames. We applied the algorithm to imaging studies from eight patients with metastatic lesions in the liver and assessed improvements in original versus motion corrected 3D DCE‐US cine using: (i) frame‐to‐frame volumetric overlap of segmented lesions, (ii) normalized correlation coefficient (NCC) between frames (similarity analysis), and (iii) sum of squared errors (SSE), root‐mean‐squared error (RMSE), and r‐squared (R2) quality‐of‐fit from fitted time‐intensity curves (TIC) extracted from a segmented lesion. Results: We noted improvements in frame‐to‐frame lesion overlap across all patients, from 68% ± 13% without correction to 83% ± 3% with MC (p = 0.023). Frame‐to‐frame similarity as assessed by NCC also improved on two different sets of time points from 0.694 ± 0.057 (original cine) to 0.862 ± 0.049 (corresponding MC cine) and 0.723 ± 0.066 to 0.886 ± 0.036 (p ≤ 0.001 for both). TIC analysis displayed a significant decrease in RMSE (p = 0.018) and a significant increase in R2 goodness‐of‐fit (p = 0.029) for the patient cohort. Conclusions: Overall, results suggest decreases in 3D DCE‐US motion after applying the proposed algorithm. [ABSTRACT FROM AUTHOR]

The democratization of ultrasound imaging refers to the process of making ultrasound technology more accessible. Traditionally, ultrasound imaging has been predominately used in specialized medical facilities by trained professionals. Advancements in technology and changes in the health-care landscape have inspired efforts to broaden the availability of ultrasound imaging to various settings such as remote and resource-limited areas. In this review, we highlight several key factors that have contributed to the ongoing democratization of ultrasound imaging, including portable and handheld devices, recent advancements in technology, and training and education. Examples of diagnostic point-of-care ultrasound (POCUS) imaging used in emergency and critical care, gastroenterology, musculoskeletal applications, and other practices are provided for both human and veterinary medicine. Open challenges and the future of POCUS imaging are presented, including the emerging role of artificial intelligence in technology development. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the fifth leading cause of cancer‐related deaths in women and the most lethal gynecologic cancer. It is curable when discovered at an early stage, but usually remains asymptomatic until advanced stages. It is crucial to diagnose the disease before it metastasizes to distant organs for optimal patient management. Conventional transvaginal ultrasound imaging offers limited sensitivity and specificity in the ovarian cancer detection. With molecularly targeted ligands addressing targets, such as kinase insert domain receptor (KDR), attached to contrast microbubbles, ultrasound molecular imaging (USMI) can be used to detect, characterize and monitor ovarian cancer at a molecular level. In this article, the authors propose a standardized protocol is proposed for the accurate correlation between in‐ vivo transvaginal KDR‐targeted USMI and ex vivo histology and immunohistochemistry in clinical translational studies. The detailed procedures of in vivo USMI and ex vivo immunohistochemistry are described for four molecular markers, CD31 and KDR with a focus on how to enable the accurate correlation between in vivo imaging findings and ex vivo expression of the molecular markers, even if not the entire tumor could can be imaged by USMI, which is not an uncommon scenario in clinical translational studies. This work aims to enhance the workflow and the accuracy of characterization of ovarian masses on transvaginal USMI using histology and immunohistochemistry as reference standards, which involves sonographers, radiologists, surgeons, and pathologists in a highly collaborative research effort of USMI in cancer. [ABSTRACT FROM AUTHOR]

Ultrasound-stimulated microbubbles (USMB) cause localized vascular effects and sensitize tumors to radiation therapy (XRT). We investigated acoustic parameter optimization for combining USMB and XRT. We treated breast cancer xenograft tumors with 500 kHz pulsed ultrasound at varying pressures (570 or 740 kPa), durations (1 to 10 minutes), and microbubble concentrations (0.01 to 1% (v/v)). Radiation therapy (2 Gy) was administered immediately or after a 6-hour delay. Histological staining of tumors 24 hours after treatment detected changes in cell morphology, cell death, and microvascular density. Significant cell death resulted at 570 kPa after a 1-minute exposure with 1% (v/v) microbubbles with or without XRT. However, significant microvascular disruption required higher ultrasound pressure and exposure duration greater than 5 minutes. Introducing a 6-hour delay between treatments (USMB and XRT) showed a similar tumor effect with no further improvement in response as compared to when XRT was delivered immediately after USMB. [ABSTRACT FROM AUTHOR]

This work proposes an interpretable radiomics approach to differentiate between malignant and benign focal liver lesions (FLLs) on contrast-enhanced ultrasound (CEUS). Although CEUS has shown promise for differential FLLs diagnosis, current clinical assessment is performed only by qualitative analysis of the contrast enhancement patterns. Quantitative analysis is often hampered by the unavoidable presence of motion artifacts and by the complex, spatiotemporal nature of liver contrast enhancement, consisting of multiple, overlapping vascular phases. To fully exploit the wealth of information in CEUS, while coping with these challenges, here we propose combining features extracted by the temporal and spatiotemporal analysis in the arterial phase enhancement with spatial features extracted by texture analysis at different time points. Using the extracted features as input, several machine learning classifiers are optimized to achieve semiautomatic FLLs characterization, for which there is no need for motion compensation and the only manual input required is the location of a suspicious lesion. Clinical validation on 87 FLLs from 72 patients at risk for hepatocellular carcinoma (HCC) showed promising performance, achieving a balanced accuracy of 0.84 in the distinction between benign and malignant lesions. Analysis of feature relevance demonstrates that a combination of spatiotemporal and texture features is needed to achieve the best performance. Interpretation of the most relevant features suggests that aspects related to microvascular perfusion and the microvascular architecture, together with the spatial enhancement characteristics at wash-in and peak enhancement, are important to aid the accurate characterization of FLLs. [ABSTRACT FROM AUTHOR]

Background: High-dose radiotherapy (>8-10 Gy) causes rapid endothelial cell death via acid sphingomyelinase (ASMase)-induced ceramide production, resulting in biologically significant enhancement of tumor responses. To further augment or solicit similar effects at low radiation doses, we used genetic and chemical approaches to evaluate mechano-acoustic activation of the ASMase-ceramide pathway by ultrasound-stimulated microbubbles (USMB).Methods: Experiments were carried out in wild-type and acid sphingomyelinase (asmase) knockout mice implanted with fibrosarcoma xenografts. A cohort of wild-type mice received the ASMase-ceramide pathway inhibitor sphingosine-1-phosphate (S1P). Mice were treated with varying radiation doses, with or without a priori USMB exposure at different microbubble concentrations. Treatment response was assessed with quantitative 3D Doppler ultrasound and immunohistochemistry at baseline, and at three, 24, and 72 hours after treatment, with three to five mice per treatment group at each time point. All statistical tests were two-sided.Results: Results confirmed an interaction between USMB and ionizing radiation at 24 hours (P < .001), with a decrease in tumor perfusion of up to 46.5% by three hours following radiation and USMB. This peaked at 24 hours, persisting for up to 72 hours, and was accompanied by extensive tumor cell death. In contrast, statistically nonsignificant and minimal tumor responses were noted in S1P-treated and asmase knockout mice for all treatments.Conclusions: This work is the first to confirm the involvement of the ASMase-ceramide pathway in mechanotransductive vascular targeting using USMB. Results also confirm that an acute vascular effect is driving this form of enhanced radiation response, and that it can be elicited at low radiation doses (<8-10 Gy) by a priori USMB exposure. [ABSTRACT FROM AUTHOR]

Evidence suggests that compression and shear wave elastography are sensitive to the mechanical property changes occuring in dying cells following chemotherapy, and can hence be used to monitor cancer treatment response. A qualitative and quantitative understanding of the mechanical changes at the cellular level would allow to better infer how these changes affect macroscopic tissue mechanical properties and therefore allow the optimization of elastographic techniques (such as shear wave elastography) for the monitoring of cancer therapy. We used intracellular particle tracking microrheology (PTM) to investigate the mechanical property changes of cells exposed to paclitaxol, a mitotic inhibitor used in cancer chemotherapy. The average elastic and viscous moduli of the cytoplasm of treated MCF- 7 breast cancer cells were calculated for frequency ranges between 0.2 and 100 rad s-1 (corresponding to 0.03 and 15.92 Hz, respectively). A significant increase in the complex shear modulus of the cell cytoplasm was detected at 12 h post treatment. At 24 h after drug exposure, the elastic and viscous moduli increased by a total of 191.3 Pa (>8000×) and 9 Pa (~9×), respectively for lowfrequency shear modulus measurements (at 1 rad s-1). At higher frequencies (10 rad s-1), the elastic and viscous moduli increased by 188.5 Pa (~60×) and 1.7 Pa (~1.1×), respectively. Our work demonstrates that PTM can be used to measure changes in the mechanical properties of treated cells and that cell elasticity significantly increases by 24 h after chemotherapy exposure. [ABSTRACT FROM AUTHOR]