Comperative analysis of accuracy between low-frequency ultrasound biomicroscopy and 14-MHz ultrasonography with tissue harmonic imaging for the evaluation of the posterior lens capsule in traumatic cataracts

Background To compare the accuracy of low-frequency ultrasound biomicroscopy (LFUBM) and 14-MHz ultrasonography with tissue harmonic imaging (14-MHz + THI) in the assessment of posterior capsule (PC) integrity in patients with traumatic cataracts (TCs). Methods From January 2019 to October 2020, 51 patients (51 eyes) with TCs who were scheduled for cataract extraction and for whom the PC of the lens could not be observed by the slit lamp visited Tianjin Eye Hospital, including 47 patients (47 eyes) with a penetrating injury of the eyeball and 4 patients (4 eyes) with a blunt injury of the eyeball. All eyes underwent LFUBM and 14-MHz + THI examinations before cataract extraction to determine the integrity of the PC. The integrity of the PC observed in surgery was the actual findings, and the consistency between the 2 methods was assessed in terms of the preoperative examination and intraoperative findings. Fisher’s exact test was used for consistency analysis, and P < 0.05 was considered statistically significant. Results Thirty-two eyes with ruptured PCs and 19 eyes with intact PCs were actual findings in surgery. Thirty eyes with ruptured PCs and 21 eyes with intact PCs were examined by LFUBM. Thirty-two eyes with ruptured PCs and 19 eyes with intact PCs were examined by 14-MHz + THI. There were no significant differences between the 2 methods and the intraoperative findings (P = 0.293 LFUBM, P = 0.623 14-MHz + THI). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LFUBM and 14-MHz + THI were 91 and 94%, 95 and 89%, 97 and 94%, 86 and 89% and 92 and 92%, respectively. Conclusions Both LFUBM and 14-MHz + THI were proved to have high levels sensitivity and specificity in diagnosing the status of the PC in TC and they can be used as accurate diagnostic tool in these cases.

Interleaved Array Transducer with Polarization Inversion Technique to Implement Ultrasound Tissue Harmonic Imaging

In ultrasound tissue harmonic imaging (THI), it is preferred that the bandwidth of the array transducer covers at least the fundamental frequency f0 for transmission and the second harmonic frequency 2f0 for reception. However, it is challenging to develop an array transducer with a broad bandwidth due to the single resonance characteristics of piezoelectric materials. In this study, we present an improved interleaved array transducer suitable for THI and a dedicated transducer fabrication scheme. The proposed array transducer has a novel structure in which conventional elements exhibiting f0 resonant frequency and polarization-inverted elements exhibiting 2f0 resonant frequency are alternately located, and the thicknesses of all piezoelectric elements are identical. The performance of the proposed method was demonstrated by finite element analysis (FEA) simulations and experiments using a fabricated prototype array transducer. Using the proposed technique, f0 and 2f0 frequency ultrasounds can be efficiently transmitted and received, respectively, resulting in a 90% broad bandwidth feature of the transducer. Thus, the proposed technique can be one of the potential ways to implement high resolution THI.

Diagnosis of Biliary Tract Disease Based on Ultrasound Tissue Harmonic Imaging

With the deepening of ultrasound imaging research, studying nonlinear phenomena in medical ultrasound will help people to further improve the existing diagnostic level. Harmonic imaging technology generated in recent years is an effective new technology for nonlinear acoustics in ultrasonic diagnosis. Patients with biliary tract lesions generally have few symptoms, which are often detected by chance during physical examination. Ultrasonography is currently the preferred diagnostic method for biliary tract disease. The application of tissue harmonic imaging (THI) can effectively eliminate many near-field misdiagnosed images, enhance the tissue echo of deep tissues or organs, and significantly improve signal-to-noise ratio and resolution. At the same time, it can better display the subtle features of biliary diseases, thereby reducing the rate of missed diagnosis and improving the accuracy of diagnosis. Therefore, this study aimed to observe the changes of ultrasound images in the lesions and surrounding tissues of several biliary lesions by ultrasound tissue harmonic imaging technology, and realized the diagnosis in the early stage of the disease by means of tissue harmonic imaging technology, then provided objective quantitative indicators for the diagnosis of biliary diseases. Also, this study confirmed that tissue harmonic imaging technology can significantly improve the ultrasound image resolution of biliary tract disease, clearly showing the sub-acute gallbladder wall, gallbladder wall, gallbladder cavity in the acute and chronic inflammation and the presence of subtle changes in the tumor. This can provide a rich diagnostic value for the clinic and has practical significance for clinical treatment.

Adaptive Ultrasound Tissue Harmonic Imaging Based on an Improved Ensemble Empirical Mode Decomposition Algorithm

Complete and accurate separation of harmonic components from the ultrasonic radio frequency (RF) echo signals is essential to improve the quality of harmonic imaging. There are limitations in the existing two commonly used separation methods, that is, the subjectivity for the high-pass filtering (S_HPF) method and motion artifacts for the pulse inversion (S_PI) method. A novel separation method called S_CEEMDAN, based on the complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN) algorithm, is proposed to adaptively separate the second harmonic components for ultrasound tissue harmonic imaging. First, the ensemble size of the CEEMDAN algorithm is calculated adaptively according to the standard deviation of the added white noise. A set of intrinsic mode functions (IMFs) is then obtained by the CEEMDAN algorithm from the ultrasonic RF echo signals. According to the IMF spectra, the IMFs that contain both fundamental and harmonic components are further decomposed. The separation process is performed until all the obtained IMFs have been divided into either fundamental or harmonic categories. Finally, the fundamental and harmonic RF echo signals are obtained from the accumulations of signals from these two categories, respectively. In simulation experiments based on CREANUIS, the S_CEEMDAN-based results are similar to the S_HPF-based results, but better than the S_PI-based results. For the dynamic carotid artery measurements, the contrasts, contrast-to-noise ratios (CNRs), and tissue-to-clutter ratios (TCRs) of the harmonic images based on the S_CEEMDAN are averagely increased by 31.43% and 50.82%, 18.96% and 10.83%, as well as 34.23% and 44.18%, respectively, compared with those based on the S_HPF and S_PI methods. In conclusion, the S_CEEMDAN method provides improved harmonic images owing to its good adaptivity and lower motion artifacts, and is thus a potential alternative to the current methods for ultrasonic harmonic imaging.

Application of 14-MHz Ultrasonography with Tissue Harmonic Imaging to Determine Posterior Capsule Integrity in Traumatic Cataract

Purpose. To report the application of 14-MHz ultrasonography with tissue harmonic imaging (14 MHz + THI) to determine the integrity of the posterior capsule (PC) in traumatic cataract (TC). Methods. Patients with TC who were scheduled to undergo cataract extraction and whose PC could not be observed by slit lamp examination were included in the study. The status of the PC was determined by 14 MHz + THI before cataract extraction and confirmed during surgery. The results regarding PC integrity obtained from 14 MHz + THI and intraoperative direct observation were compared. Result. The study enrolled 52 eyes of 52 patients (49 men and 3 women), with a mean age of 42.15 years ± 11.23 (SD). The nature of the trauma was blunt (3 eyes) or sharp (49 eyes). The 14 MHz + THI method showed 21 PCs to be intact and 31 to have ruptured before cataract surgery. During surgery, 23 PCs were observed to be intact, while 29 PCs were ruptured. 27 PCs were ruptured and 19 were intact, as determined by the two methods. The 14 MHz + THI observations were consistent with the intraoperative observations of the PC (kappa = 0.764), with no significant difference between the two methods (P=0.687). The sensitivity, specificity, and accuracy of 14 MHz + THI for observation of the PC were 93.10%, 82.60%, and 88.46%, respectively. Conclusion. The 14 MHz + THI method can accurately reveal the integrity of the PC in TC. It has important clinical value in the selection of cataract surgery methods and the prediction of complications during TC surgery.