Ultrasound Elastography Medic VN

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Gii thiu cc my siu m n hi ti trung tm Y khoa MEDIC, Vit nam.

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<ul><li>1.SIU M N HI [ ULTRASONIC ELASTOGRAPHY ] TRUNG TM Y KHOA MEDIC HA HO 15-12-2011</li></ul> <p>2. </p> <ul><li>Siu m n hi = Palpation Imaging</li></ul> <ul><li>(to hnh siu m bngcch s) </li></ul> <p>I CNG 3. I CNG </p> <ul><li>FibroScan : siu m n hi Trung tm Y khoa MEDIC Ho Ho (t 2005) </li></ul> <p>4. I CNG </p> <ul><li>Nguyn l ca siu m n hi :</li></ul> <ul><li>- m bin dng khi b n t ngoi / t trong.</li></ul> <ul><li>-tn thng/ m p ng theo nhiu cch, ty thuc cu to c hc. </li></ul> <ul><li>-m bnh thng, mm, bin dng nhiu trong khi m bnh l, cng hn, bin dng t hn.</li></ul> <ul><li>-Bn n hi (elastogram)= Hnh c tng phn ca m do khc bit cng, c m ha mu ty nh sn sut (=cng xanh=mm). </li></ul> <p>5. ELASTOGRAM ca NHN GIP 6. I CNG </p> <ul><li>Chiu kch mi = kho st c tnh n hi ca m mm ( cng, nht).</li></ul> <ul><li>nhiu loi m mm c cng sinh echo nhng c c tnh c hc khc nhau, gip phn bit c tn thng bnh l. </li></ul> <ul><li>da vo khc bit v cng (stiffness) ca tn thng c tnh v lnh tnh, p dng vo nhiu c quan: gan,v, gip, tuyn tin lit, v.v </li></ul> <p>7. TO HNH N HINH TNH v NH LNG </p> <ul><li>Relative stiffness= cng tng i </li></ul> <ul><li>Shear wave speed= o tc sng bin dng </li></ul> <ul><li>Shape = dng tn thng </li></ul> <ul><li>Size= kch thc tn thng </li></ul> <ul><li>--------------------------------------------------- </li></ul> <ul><li>To hnh n hi cho dng v kch thc tn thng khc hn hnh B-mode </li></ul> <p>8. FibroScan : Nguyn l Gan cng cng, sng bin dng truyn cng nhanh Sandrin et al. UMB 2003; 12: 1705-13 V S= 1,0 m/s % -5 05Depth (mm) Time (ms) 0 20 40 60 10 20 30 40 50 60 E = 3.0 kPa F0 % -5 05Depth (mm) Time (ms) 0 20 40 60 10 20 30 40 50 60 E = 7.7 kPa F2 V S= 1,6 m/s % -5 05Depth (mm) Time (ms) 0 20 40 60 10 20 30 40 50 60 E = 27.0 kPa F4 V S= 3,0 m/s 9. SO SNH ELASTOGRAM v HNH SIU M QUY C Phi= Hnh B-mode / Tri=Elastogram Hnh siu m Doppler quy c 10. SO SNH ELASTOGRAM v HNH SIU M QUY C 11. SO SNH ELASTOGRAM v HNH SIU M QUY C 12. BN CHT TO HNH N HI </p> <ul><li>2 loi chnh = tnh (static), ng (dynamic) + static (da vo strain [lm cng ra]) = to hnh chuyn ng bn trong (internal motion) di s bin dng tnh (static deformation) vi kch thch t ngoi. + dynamic (da vo sng m)= to hnh bng truyn sng bin dng (shear wave propagation) vi kch thch trong m. </li></ul> <p>13. 14. CC LOI MY SIU M N HI </p> <ul><li>-External compression gy ra khc bit bin dng m tng i nh my siu m Philips, GE, Hitachi, Siemens Antares. -Shear wave based elastography (on hi sng bin dng)nh ca my: </li></ul> <ul><li>+ FibroScan (Echosens) + Acuson S2000TM, Siemens vi xung lc bc x m Acoustic Radiation Force Impulse Imaging(ARFI) + SuperSonic Imagine, Aixplorer vi supersonic shear imaging (SSI, to hnh sng bin dng siu thanh). </li></ul> <p>15. 16. MT S THUT NG </p> <ul><li>1.Shear Wave : sng bin dng, cn gi l sng ngang, lmt bin dngn hithng gc vi hng chuyn ng ca sng. Compression Wave : sng nn, cn gi l sng dc, l mt nn vo mi trng. </li></ul> <ul><li>2.Lc bc x m(acoustic radiation force) l kt qu t momentum transfer (chuyn i ng lng) t sng siu m lan truyn n m. C cc phng thc p dng lc bc x m:tnh(static),thong qua(transient), hocc tnh ho m(harmonically). </li></ul> <p>17. MT S THUT NG </p> <ul><li>3.Elasticity Imaging Methods:Ngoi kch thch c hc l chuyn ng m sinh l (mch p), nu= - dng ngun rung ng (vibration) t ngoi to sng bin dng trong m=sonoelasticity. - dng ngun nn tnh bn ngoi (external static compression) kch thch c hc =strain imaging. - thun tin hn 2 cch t ngoi k trn, dng lc bc x m (Sugimoto xut u tin, 1990) kt hp trc tip trong m=shear wave elasticity imaging(Sarvazyan v cs, Nightingale v cs, Bercoff v cs., Fink v cs). </li></ul> <p>18. MT S THUT NG </p> <ul><li>4.Young's modulus = gi tr tuyt i n hi Young, bin dng theo chiu dcvi p lc dc. </li></ul> <ul><li>5.Shear modulus =bin dng theo chiu ngangvi truyn sng bin dng trong mi trng ng nht ng hng (isotropic homogeneous media). </li></ul> <ul><li>6.Bulk modulus =bin dng khi , thay i th tch ca vt cht theo c 2 chiu, do kch thch t ngoi. </li></ul> <p>19. Hitachi Real-Time Elastography (HiRTE) 20. Hitachi Real-Time Elastography (HiRTE) 21. Hitachi Real-Time Elastography (HiRTE) 22. Hitachi Real-Time Elastography (HiRTE) 23. Siu m n hi Trung tm Y khoa Medic Ho Ho </p> <ul><li>FibroScan (transient elastography) cho x ho gan,</li></ul> <ul><li>Supersonic Imagine ( SSI, supersonic shearimaging),</li></ul> <ul><li> Acuson S2000 (ARFI)</li></ul> <ul><li>cho cc loi bnh l tuyn v, tuyn gip, theo di x ho gan, bnh l c khp, phn mm v da.</li></ul> <p>24. FibroScan 25. TRANSIENT ELASTOGRAPHY ca FibroScan (FS) 26. Siu m n hi (FibroScan ) =100 xSinh thit gan 2.5 cm Th tch kho st 4 cm 1 cm 27. TRANSIENT ELASTOGRAPHY ca FibroScan (FS) </p> <ul><li>Hn ch= </li></ul> <ul><li>- khng thy vng ROI </li></ul> <ul><li>- 1-D broadband 50Hz </li></ul> <ul><li>- th tch 4cm3 </li></ul> <ul><li>- khng khm c ngi bo ph, trn dch bng, kh pht hin gan ha x khng ng dng </li></ul> <p>28. 29. SUPERSONIC SHEAR IMAGING (SSI) ca SUPERSONIC IMAGINE, Ai X plorer 30. Bidimensional liver elasticity maps assessed using the supersonic shear imaging (SSI) technique superimposed to the corresponding B-scan. The Youngs modulus representing the liver stiffness is represented in color levels. (a): patient 59 - F1. = 5 4.78 +/- 0.83 kPa (b): patient 51 - F2. E = 10.64 +/- 1.10 kPa (c): patient 39 - F3. E = 14.52 +/- 2.20 kPa (d): patient 22 - F4. E = 27.43 +/- 2.64 kPa. ricBavu, Jean-LucGennisson, MathieuCouade, JeremyBercoff, VincentMallet, MathiasFink, AnneBadel , AnasVallet-Pichard,Bertrand Nalpas , MickalTanter, StanislasPol: Noninvasive In Vivo Liver Fibrosis Evaluation Using Supersonic Shear Imaging: A Clinical Study on 113 Hepatitis C Virus Patients, Ultrasound in Medicine and Biology , Volume 37, Issue 9 , Pages 1361-1373, September 2011 . 31. SHEAR WAVEELASTOGRAPHYwith SUPERSONIC SHEAR IMAGINGof 69 LIVER TUMORS PHUC VINH DINH LE, THU DUY NGUYEN, HUNG THIEN NGUYEN, HAI THANH PHAN MEDIC MEDICAL CENTER, HCMC, VIETNAM 32. 33. Shear Wave Elastographyof 724 Breast Tumor Cases THU DUY NGUYEN, HUNG THIEN NGUYEN, HAI THANH PHAN MEDIC MEDICAL CENTER, HCMC,VIETNAM 34. 35. SSI </p> <ul><li>Hn ch= </li></ul> <ul><li>- kh khm vng su </li></ul> <ul><li>- n v kPa, kh so snh vi my khc c n v mt/giy</li></ul> <ul><li>- ch o bin dng ngang (shear modulus) </li></ul> <p>36. ARFI ca ACUSON S2000, SIEMENS 37. ARFI ca ACUSON S2000, SIEMENS 38. ARFI </p> <ul><li>Hn ch: </li></ul> <ul><li>- chm hn SSI </li></ul> <ul><li>- nhy vi ng tc th (bng), mch p (gip) </li></ul> <ul><li>- ch o bin dng ngang (shear modulus)</li></ul> <p>39. 40. ARFI vi BNG v GIP </p> <ul><li>tinh kh thi</li></ul> <ul><li>s o cua cc c quan khc nhau co y nghia.</li></ul> <ul><li>lch co tc ARFI trung binh cao nht , theo sau l thn, tuyn gip, tuyn ty v tuyn tin lit;thp nht thng thy gan .</li></ul> <ul><li>Cc s o thn v lch cho thy lch chun cao. ----------------------------- </li></ul> <ul><li>Ngun: An abdominal and thyroid status with Acoustic Radiation Force Impulse Elastometry-A feasibility study Acoustic Radiation Force Impulse Elastometry of human organs. Goertz RS, Amann K, Heide R, Bernatik T, Neurath MF, Strobel D,Eur J Radiol. 2010 Oct 22. </li></ul> <p>41. 42. 43. KT LUN </p> <ul><li>Kho st c tnh n hi ca m mm ( cng, nht) ca siu m n hi l b sung ng gi cho B-mode v Doppler. </li></ul> <ul><li>ng dng vo lm sng thn, tin lit tuyn </li></ul> <ul><li>Tng lai:</li></ul> <ul><li>-viscoelastic v poroelastic;</li></ul> <ul><li>-ng dng HIFU;</li></ul> <ul><li>-bnh l myocardial hoc intravascular ;</li></ul> <ul><li>- chm cu; </li></ul> <ul><li>- siu m n hi 3D v 4D. </li></ul>