Gregory R. Bashford

Tendinopathy Discrimination by Use of Spatial Frequency Parameters in Ultrasound B-Mode Images

The structural characteristics of a healthy tendon are related to the anisotropic speckle patterns observed in ultrasonic images. This speckle orientation is disrupted upon damage to the tendon structure as observed in patients with tendinopathy. Quantification of the structural appearance of tendon shows promise in creating a tool for diagnosing, prognosing, or measuring changes in tendon organization over time. The current work describes a first step taken towards this goal - classification of Achilles tendon images into tendinopathy and control categories. Eight spatial frequency parameters were extracted from regions of interest on tendon images, filtered and classified using linear discriminant analysis. Resulting algorithms had better than 80% accuracy in categorizing tendon image kernels as tendinopathy or control. Tendon images categorized wrongly provided for an interesting clinical association between incorrect classification of tendinopathy kernels as control and the symptom and clinical time history based inclusion criteria. To assess intersession reliability of image acquisition, the first 10 subjects were imaged twice during separate sessions. Test-retest of repeated measures was excellent with one outlier) indicating a general consistency in imaging techniques.

Combination of hormone replacement therapy and high physical activity is associated with differences in Achilles tendon size in monozygotic female twin pairs

Estrogen concentration has been suggested to play a role in tendon abnormalities and injury. In physically active postmenopausal women, hormone replacement therapy (HRT) has been suggested to decrease tendon diameter. We hypothesized that HRT use and physical activity are associated with Achilles tendon size and tissue structure. The study applied cotwin analysis of fourteen 54- to 62-yr-old identical female twin pairs with current discordance for HRT use for an average of 7 yr. Achilles tendon thickness and cross-sectional areas were determined by ultrasonography, and tendon structural organization was analyzed from the images using linear discriminant analysis (LDA). Maximal voluntary and twitch torques from plantar flexor muscles were measured. Serum levels of estradiol, estrone, testosterone, and sex hormone binding globulin were analyzed. Total daily metabolic equivalent score (MET-h/day) was calculated from physical activity questionnaires. Results showed that, in five physically active (MET > 4) pairs, the cotwins receiving HRT had greater estradiol level (P = 0.043) and smaller tendon cross-sectional area than their sisters (63 vs. 71 mm(2), P = 0.043). Among all pairs, Achilles tendon thickness and cross-sectional area did not significantly differ between HRT using and nonusing twin sisters. Intrapair correlation for Achilles tendon thickness was high, despite HRT use discordance (r = 0.84, P < 0.001). LDA distinguished different tendon structure only from two of six examined twin pairs who had a similar level of physical activity. In conclusion, the effect of HRT on Achilles tendon characteristics independent of genetic confounding may be present only in the presence of sufficient physical activity. In physically active twin pairs, the higher level of estrogen seems to be associated with smaller tendon size.

Ultrasound three-dimensional velocity measurements by feature tracking

This article describes a new angle-independent method suitable for three-dimensional (3-D) blood flow velocity measurement that tracks features of the ultrasonic speckle produced by a pulse echo system. In this method, a feature is identified and followed over time to detect motion. Other blood flow velocity measurement methods typically estimate velocity using one- (1-D) or two-dimensional (2-D) spatial and time information. Speckle decorrelation due to motion in the elevation dimension may hinder this estimate of the true 3-D blood flow velocity vector. Feature tracking is a 3-D method with the ability to measure the true blood velocity vector rather than a projection onto a line or plane. Off-line experiments using a tissue phantom and a real-time volumetric ultrasound imaging system have shown that the local maximum detected value of the speckle signal may be identified and tracked for measuring velocities typical of human blood flow. The limitations of feature tracking, including the uncertainty of the peak location and the duration of the local maxima are discussed. An analysis of the expected error using this method is given.

Ultrasound based quantitative motion measurement using speckle size estimation

An ultrasound system determines the relative movement in a first direction (F1) of first matter, such as blood flow, and second matter, such as an artery wall, in a subject under study (S). A beam (B1) of ultrasound waves defining a plurality of beam positions (BP1 and BP2) and beam axes (A1and A2) are moved in scan directions having components parallel to direction F1. First and second blocks of data representing the first and second matter, respectively, are generated. A processor (20) performs an estimation of speckle size on first data to obtain a first result, and performs analysis of the second block of data to obtain a second result. The two results are analyzed to obtain a measure of the relative movement of the first and second matter.

Patellar tendon morphology in volleyball athletes with and without patellar tendinopathy

Appropriate management of patellar tendinopathy requires distinguishing between inflammatory and degenerative conditions, often difficult because tendon thickening can be a normal or pathological adaptation, and micromorphology is not observable on clinical imaging. The purpose of this study was to quantitatively examine patellar tendon micro‐ and macromorphology in volleyball athletes and relate those findings to reported symptoms. Longitudinal ultrasound images of proximal and distal patellar tendons were acquired from 84 male elite volleyball athletes (44 symptomatic, 40 asymptomatic) and 10 asymptomatic nonathlete controls. Micromorphology was determined using two‐dimensional Fast Fourier Transform analysis providing a discriminating peak spatial frequency parameter (PSF). Macromorphology (patellar tendon thickness) was measured using Image J software. All athletes regardless of symptoms had thicker proximal tendons compared to nonathletes, suggesting a normal adaptation to training loads. However, symptomatic athletes demonstrated lower PSF than asymptomatic athletes and nonathletes at the proximal tendon, suggesting greater collagen disorganization, and tendon degeneration rather than inflammation. Only symptomatic athletes had thicker distal tendons than nonathletes, but there was no difference in PSF distally. Diagnostic ultrasound enhances the understanding of the micromorphology of patellar tendons, supporting the rationale for management that remodels the degenerated tendon instead of treating inflammation.

Lateral blood flow velocity estimation based on ultrasound speckle size change with scan velocity

Conventional (Doppler-based) blood flow velocity measurement methods using ultrasound are capable of resolving the axial component (i.e., that aligned with the ultrasound propagation direction) of the blood flow velocity vector. However, these methods are incapable of detecting blood flow in the direction normal to the ultrasound beam. In addition, these methods require repeated pulse-echo interrogation at the same spatial location. A new method has been introduced which estimates the lateral component of blood flow within a single image frame using the observation that the speckle pattern corresponding to blood reflectors (typically red blood cells) stretches (i.e., is smeared) if the blood is moving in the same direction as the electronically-controlled transducer line selection in a 2-D image. The situation is analogous to the observed distortion of a subject photographed with a moving camera. The results of previous research showed a linear relationship between the stretch factor (increase in lateral speckle size) and blood flow velocity. However, errors exist in the estimation when used to measure blood flow velocity. In this paper, the relationship between speckle size and blood flow velocity is investigated further with both simulated flow data and measurements from a blood flow phantom. It can be seen that: 1) when the blood flow velocity is much greater than the scan velocity (spatial rate of A-line acquisition), the velocity will be significantly underestimated because of speckle decorrelation caused by quick blood movement out of the ultrasound beam; 2) modeled flow gradients increase the average estimation error from a range between 1.4% and 4.4%, to a range between 4.4% and 6.8%; and 3) estimation performance in a blood flow phantom with both flow gradients and random motion of scatterers increases the average estimation error to between 6.1% and 7.8%. Initial attempts at a multiple-scan strategy for estimating flow by a least-squares model suggest the possibility of increased accuracy using multiple scan velocities.

Speckle structure in three dimensions

Ultrasound speckle has long been recognized as a noise source in diagnostic imaging. The advent of three-dimensional imaging and flow detection requires the characterization of the three-dimensional acoustical speckle pattern. Ultrasound data were acquired by using an automated three-dimensional translation stage to measure the radio-frequency (rf) backscatter signals from a volume scattering phantom. The data samples were processed off-line to locate and measure envelope-detected speckle peaks, i.e., local maxima. Results indicate that speckle has a distinctive structure in which three-dimensional peaks can be located and measured. These peaks are brighter on average than the mean speckle brightness level and are uniformly distributed throughout the volume. The lateral breadth of the speckle peaks, defined as the breadth of the -6 dB contour in the lateral-elevational plane, is over twice the width predicted by previous investigators. This is the first attempt to physically measure the breadth of bright spots in the speckle pattern. A rational for the discrepancy between previous theory and the measurement in this paper is given.

Ultrasound-Based Tendon Micromorphology Predicts Mechanical Characteristics of Degenerated Tendons

The purpose of this study was to explore the relationship between tendon micro-morphology quantified from a sonogram and tendon mechanical characteristics measured in vivo. Nineteen adults (nine with unilateral Achilles tendinosis) participated. A commercial ultrasound scanner was used to capture longitudinal B-mode ultrasound images from the mid-portion of bilateral Achilles tendons and a custom image analysis program was used to analyze the spatial frequency content of manually defined regions of interest; in particular, the average peak spatial frequency of the regions of interest was acquired. In addition, a dynamometer and a motion analysis system indirectly measured the tendon mechanical (stiffness) and material (elastic modulus) properties. The peak spatial frequency correlated with tendon stiffness (r = 0.74, p = 0.02) and elastic modulus (r = 0.65, p = 0.05) in degenerated tendons, but not healthy tendons. This is the first study relating the mechanical characteristics of degenerated human Achilles tendon using a non-invasive micro-morphology analysis approach.

Near-Infrared, Surface-Enhanced Fluorescence Using Silver Nanoparticle Aggregates in Solution

Fluorescence spectroscopy is used in many life science and clinical research diagnostic assays. Improvements in the sensitivity and limit-of-detection of these assays may have profound implications. Here, we demonstrate a near-infrared, surface-enhanced fluorescence technology that increases the signal of IRDye 800CW-labeled streptavidin by up to 2,530-fold while improving the limit-of-detection 1,000-fold. Citrate-stabilized, silver nanoparticles that aggregate in solution were used with the dye-protein conjugate to form plasmon-active nanostructures. The technique is straightforward to implement and fully compatible with commercially available immunoassay instrumentation and consumables.

Resolving the lateral component of blood flow velocity based on ultrasound speckle size change with scan direction and speed

Conventional blood flow velocity measurement using ultrasound is capable of resolving the axial component (i.e., that aligned with the ultrasound propagation direction) of the blood flow velocity vector. However, these Doppler-based methods are incapable of detecting blood flow in the direction normal to the ultrasound beam. In addition, these methods require repeated pulse-echo interrogation at the same spatial location. In this paper, we introduce a method which estimates the lateral component of blood flow within a single image frame using the observation that the speckle pattern corresponding to the blood reflectors (typically red blood cells) stretches (i.e., is “smeared”) if the blood is moving in the same direction as the electronically-controlled transducer line selection in a 2D image. The situation is analogous to the observed elongation of a subject photographed with a moving camera. Here, we develop a relationship between speckle size, scan speed, and blood flow velocity. Experiments were performed with a blood flow phantom and high-frequency transducer of a commercially available ultrasound machine. Data was captured through an interface allowing access to the raw beam formed data. Blood flow with velocities ranging from 15 to 40 cm/s were investigated in this paper. Results show that there is a linear relationship between the reciprocal of the stretch factor and blood flow velocity. Two scan speeds were used in our experiments. When the scan velocity is 64.8 cm/s, compared with the theoretical model, fitting results based on experimental data gave us a linear relationship with average flow estimation error of 1.74±1.48 cm/s. When the scan velocity is 37.4 cm/s, the average estimation error is 0.65±0.45 cm/s.