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      Ultrasonic Assessment of the Medial Temporal Lobe Tissue Displacements in Alzheimer’s Disease

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          Abstract

          We aim to estimate brain tissue displacements in the medial temporal lobe (MTL) using backscattered ultrasound radiofrequency (US RF) signals, and to assess the diagnostic ability of brain tissue displacement parameters for the differentiation of patients with Alzheimer’s disease (AD) from healthy controls (HC). Standard neuropsychological evaluation and transcranial sonography (TCS) for endogenous brain tissue motion data collection are performed for 20 patients with AD and for 20 age- and sex-matched HC in a prospective manner. Essential modifications of our previous method in US waveform parametrization, raising the confidence of micrometer-range displacement signals in the presence of noise, are done. Four logistic regression models are constructed, and receiver operating characteristic (ROC) curve analyses are applied. All models have cut-offs from 61.0 to 68.5% and separate AD patients from HC with a sensitivity of 89.5% and a specificity of 100%. The area under a ROC curve of predicted probability in all models is excellent (from 95.2 to 95.7%). According to our models, AD patients can be differentiated from HC by a sharper morphology of some individual MTL spatial point displacements (i.e., by spreading the spectrum of displacements to the high-end frequencies with higher variability across spatial points within a region), by lower displacement amplitude differences between adjacent spatial points (i.e., lower strain), and by a higher interaction of these attributes.

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          Most cited references43

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          Elastography: A Quantitative Method for Imaging the Elasticity of Biological Tissues

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            The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility

            The maintenance of adequate blood flow to the brain is critical for normal brain function; cerebral blood flow, its regulation and the effect of alteration in this flow with disease have been studied extensively and are very well understood. This flow is not steady, however; the systolic increase in blood pressure over the cardiac cycle causes regular variations in blood flow into and throughout the brain that are synchronous with the heart beat. Because the brain is contained within the fixed skull, these pulsations in flow and pressure are in turn transferred into brain tissue and all of the fluids contained therein including cerebrospinal fluid. While intracranial pulsatility has not been a primary focus of the clinical community, considerable data have accrued over the last sixty years and new applications are emerging to this day. Investigators have found it a useful marker in certain diseases, particularly in hydrocephalus and traumatic brain injury where large changes in intracranial pressure and in the biomechanical properties of the brain can lead to significant changes in pressure and flow pulsatility. In this work, we review the history of intracranial pulsatility beginning with its discovery and early characterization, consider the specific technologies such as transcranial Doppler and phase contrast MRI used to assess various aspects of brain pulsations, and examine the experimental and clinical studies which have used pulsatility to better understand brain function in health and with disease.
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              Medical ultrasound: imaging of soft tissue strain and elasticity.

              After X-radiography, ultrasound is now the most common of all the medical imaging technologies. For millennia, manual palpation has been used to assist in diagnosis, but it is subjective and restricted to larger and more superficial structures. Following an introduction to the subject of elasticity, the elasticity of biological soft tissues is discussed and published data are presented. The basic physical principles of pulse-echo and Doppler ultrasonic techniques are explained. The history of ultrasonic imaging of soft tissue strain and elasticity is summarized, together with a brief critique of previously published reviews. The relevant techniques-low-frequency vibration, step, freehand and physiological displacement, and radiation force (displacement, impulse, shear wave and acoustic emission)-are described. Tissue-mimicking materials are indispensible for the assessment of these techniques and their characteristics are reported. Emerging clinical applications in breast disease, cardiology, dermatology, gastroenterology, gynaecology, minimally invasive surgery, musculoskeletal studies, radiotherapy, tissue engineering, urology and vascular disease are critically discussed. It is concluded that ultrasonic imaging of soft tissue strain and elasticity is now sufficiently well developed to have clinical utility. The potential for further research is examined and it is anticipated that the technology will become a powerful mainstream investigative tool.
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                Author and article information

                Journal
                Diagnostics (Basel)
                Diagnostics (Basel)
                diagnostics
                Diagnostics
                MDPI
                2075-4418
                03 July 2020
                July 2020
                : 10
                : 7
                : 452
                Affiliations
                [1 ]Biomedical Engineering Institute, Kaunas University of Technology, K. Baršausko g. 59-454, LT-44029 Kaunas, Lithuania; rytis.jurkonis@ 123456ktu.lt (R.J.); arunas.lukosevicius@ 123456ktu.lt (A.L.); monika.makunaite@ 123456ktu.edu (M.M.)
                [2 ]Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307 Kaunas, Lithuania; vaidas.matijosaitis@ 123456lsmuni.lt (V.M.); rymante.gleizniene@ 123456lsmuni.lt (R.G.); daiva.rastenyte@ 123456lsmuni.lt (D.R.)
                Author notes
                [* ]Correspondence: m.baranauskas@ 123456ktu.lt
                Author information
                https://orcid.org/0000-0003-0204-4886
                https://orcid.org/0000-0002-9481-1773
                https://orcid.org/0000-0002-9268-5347
                https://orcid.org/0000-0002-7714-8850
                https://orcid.org/0000-0001-9940-0255
                https://orcid.org/0000-0002-5206-3033
                https://orcid.org/0000-0002-5603-2357
                Article
                diagnostics-10-00452
                10.3390/diagnostics10070452
                7399840
                32635379
                04b6338a-7cd3-4f74-91bc-10e811b84058
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 17 June 2020
                : 01 July 2020
                Categories
                Article

                alzheimer’s disease,brain pulsation,strain,sonography,radiofrequency ultrasound,diagnostic

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