Mitsuhiro Kubota

Usefulness of ultrasonic strain measurement-based mechanical properties imaging technique-toward realization of combined short time diagnosis/treatment

For various soft tissues (e.g., liver, breast, etc.), we are developing the ultrasonic strain measurement-based mechanical properties (shear modulus, visco-shear modulus, etc.) reconstruction/imaging technique. To clarify the limitation of our quantitative reconstruction/imaging technique as a diagnostic tool for differentiating malignancies, together with improving the spatial resolution and the dynamic range we are collecting the clinical reconstruction image data. Furthermore, we are applying our technique as a monitoring technique for the effectiveness of chemotherapy (e.g., anticancer drug, ethanol, etc.), cryotherapy and thermal therapy (e.g., micro, and rf electromagnetic wave, HIFU, LASER, etc.). As soft tissues are deformed in 3-D space due to externally situated quasi-static and/or low frequency mechanical sources, multidimensional signal processing improves strain measurement accuracy, and consequently modulus reconstruction accuracy. We have verified these through simulations and phantom/animal in vitro experiments. Briefly, here we discuss the limitations of low dimensional signal processing. Moreover, both on differential diagnosis for these human in vivo malignancies and monitoring for the therapies, we exhibit the superiority of our quasi-real time imaging (using conventional US equipment) to conventional B-mode imaging. Our technique is available as a clinical visualization technique both for diagnosis and treatment, and monitored mechanical properties data can also be effectively utilized as the measure for controlling the therapies, i.e., the exposure energy, the foci, the exposure interval, etc. In the near future, suitable combination of various simple and low-invasive therapies with our imaging open up a new clinical style allowing diagnosis and the subsequently immediate treatment. This must substantially reduce the total medical expenses.

Usefulness of ultrasonic strain measurement-based mechanical properties imaging technique: toward realization of short time diagnosis/treatment

For various soft tissues (e.g., liver, breast, etc.), we are developing the ultrasonic strain measurement-based mechanical properties (shear modulus, visco-shear modulus, etc.) reconstruction/imaging technique. To clarify the limitation of our quantitative reconstruction/imaging technique as a diagnostic tool for differentiating malignancies, together with improving the spatial resolution and the dynamic range we are collecting the clinical reconstruction image data. Furthermore, we are applying our technique as a monitoring technique for the effectiveness of chemical therapy (e.g., anticancer drug, ethanol, etc.), thermal therapy (e.g., micro, and rf electromagnetic wave, HIFU, LASER, etc.), and cryotherapy. As soft tissues are deformed in 3-D space due to externally situated quasi-static and/or low frequency mechanical sources, multidimensional signal processing improves strain measurement accuracy and reduces inhomogeneity-dependent modulus reconstruction artifacts. These have been verified by us through simulations and phantom/animal in vitro experiments. Briefly, here we discuss the limitations of low dimensional signal processing. Moreover, we exhibit the superiority both on differential diagnosis for these human in vivo malignancies and monitoring for these therapies of our quasi-real time imaging (using conventional US equipment) to conventional B-mode imaging. Our technique is available as a clinical visualization technique both for diagnosis and treatment, and monitored mechanical properties data can also be effectively utilized as the measure for controlling the therapy, i.e., the exposure energy, the foci, the exposure interval, etc. In the near future, suitable combination of various simple and low-invasive therapy techniques with our imaging technique will open up a new clinical style allowing diagnosis and the subsequently immediate treatment. This must substantially reduce the total medical expenses.

IgG4-related stomach muscle lesion with a renal pseudotumor and multiple renal rim-like lesions: A rare manifestation of IgG4-related disease

Abstract We describe a 74-year-old man with immunoglobulin G4-related disease (IgG4-RD) presenting with gastric cancer, stomach and kidney lesions. For 15 years, the patient had been treated under a diagnosis of sclerosing cholangitis, which was revealed to be IgG4-RD only when the cancer was found. Histology revealed the gastric cancer and IgG4-related lesion in the muscularis propria to be separate. This case suggests that the stomach muscle can also be a site of involvement of IgG4-RD.

Role of ultrasonography in treatment selection.

In spite of difficulties impacting objectivity and reproducibility due to its dependence on the technical and diagnostic ability of each examiner, ultrasonography (US) in general can evaluate very well soft tissue lesions, especially small lesions of 1 cm or less in size. US can reliably delineate the nature of several lesions, and can detect dilated mammary ducts and lymph nodes. On the other hand, US may miss ductal spread or lymph node metastasis of breast cancer, especially if the lesions are too minute to be detected by the instrument. US should be used together with X-ray or MR mammography to prevent false negative cases. US is useful for evaluating the local nature and characteristics of cancerous lesions such as size, invasiveness, histological type, intraductal spread etc, and can evaluate regional lymph node and liver metastasis for pre-treatment staging. In addition, US-guided techniques are essential for preoperative pathological diagnosis by FNAC or CNB and for marking the marginal line for partial mastectomy. US should be more actively used to monitor intra-mammary recurrence after breast conserving surgery.

Draft Diagnostic Guidelines for Non-Mass Image-Forming Lesions by the Japan Association of Breast and Thyroid Sonology (JABTS) and the Japan Society of Ultrasonics in Medicine

We have reported the Diagnostic Guidelines for Non-Mass Image-Forming Lesions. These have been discussed in the subcommittee of the Japan Association of Breast and Thyroid Sonology (JABTS) and the Japan Society of Ultrasonics in Medicine.

Margin, Border, and Boundary Zone of Breast Tumor Ultrasonography

To make a standard diagnosis, it is important to have a standard lexicon. Although many kinds of expression are possible for the same feature of a breast tumor, a technical term must be a word that is seldom confused with another different concept. Especially, a halo or boundary high echo must be a word that is used to express a malignant sign.

Revised Diagnostic Criteria for the Breast (Draft): Internal Echoes

Many aspects of internal echoes of mass image-forming breast lesions have been discussed. These points, as well as other themes, should be documented or corrected through further investigation in wide clinical practice.