Purpose: The objective of the present study is to visualize propagation of myocardial stretching in the left ventricle by measuring the axial strain rate on the ultrasound beam (aSR). Subjects and Methods: Twenty healthy volunteers and six additional cases with informed consent were enrolled in the study. The RF signal was obtained by sparse scan in which high-frame-rate imaging was realized by reduction of scanning line density. Phase differential tracking was applied to the RF signal to obtain high temporal aSR. The aSR of each scanning line was obtained in the left ventricular (LV) long-axis view and multiple LV short-axis views with different scan angles. Results and Discussion: The LV long-axis view showed the propagation of the myocardial contraction from the LV apex to the base from the late diastole to isovolumic contraction phase. Thus, both contraction and relaxation were observed in the same cardiac phase. The multiple LV short-axis views showed that clockwise rotation occurred in the systole and anticlockwise rotation occurred in the diastole at the basal and mid portions. The LV short-axis views at the apex showed that contraction first occurred in the endocardium and propagated to the epicardium with strong contraction toward the endocardium. Anticlockwise rotation was observed in the systole and clockwise rotation was observed in the diastole. These results suggested that the contraction of the myocardium was non-uniform, and that the method had potential to show propagation of myocardial stretching in the cardiac conduction system and ordinary myocardium. Conclusion: Measurement of high temporal resolution aSR from multiple angles visualized not only local myocardial contraction but also spatial and temporal inhomogeneity of myocardial stretching in the whole heart. Evaluation of cardiac contraction with aSR measurement may provide important information for understanding cardiac pump function.

Purpose: Ultrasonography-derived carotid artery intima-media thickness (IMT) has been established as an early atherosclerotic imaging biomarker. The IMT reference value of a healthy person is approximately 0.1×(every 10 years of age) + 0.2 (mm); accordingly, it requires an accuracy of at least 0.1 mm. However, one concern of IMT measurement is the intervendor variability. In this study, we aimed to verify the intervendor variability by IMT phantom. Methods: IMT phantom was developed by improvement, and it was possible to analyze the IMT by software on all vendors. Results: In the vendor-specific software, the maximum difference between the devices was 0.08 mm, and the difference in quartile range was 0.06 mm. On the other hand, in the vendor-independent offline software, the maximum difference between the devices was 0.16 mm, and the quartile range of variation was 0.06 mm. Conclusion: The intervendor variability assessed by the IMT phantom was less than 0.10 mm, and the on-board vendor-specific software was shown to reduce the difference between the devices significantly compared with the vendor-independent off-line software. To further improve the vender difference, adjustment by vendor-specific software based on the standardized IMT phantom is warranted.

Purpose: The incidence of pneumonia is increasing with the increase in the elderly population. Although lung ultrasonography can be useful to diagnose pneumonia, there are not enough studies on the diagnostic accuracy of Lung point-of-care ultrasound (LPOCUS) in the elderly. The aim of the present study is to evaluate the diagnostic accuracy of LUS with a mobile US scanner for pneumonia in elderly patients. Method: Subjects were 101 elderly patients(mean age 87.1 years, 57 males) admitted to our hospital with suspected pneumonia between January 1 and December 31, 2019. LPOCUS was performed using a mobile ultrasound scanner, and the results were compared with those of diagnosis by blood test, chest X-ray, and chest CT. Diagnosis of pneumonia by LPOCUS was defined as multiple Blines(mBline) or consolidation. Diagnosis of heart failure required mBline in two areas or more on both sides, and presence of one or more of the following: IVC diameter 2 cm≤, respiratory variation ≤50%, ratio of right ventricle to left ventricle 1≤, and bilateral pleural effusion. Results: Of the 101 cases, 72 cases were comprehensively diagnosed with pneumonia, eight cases with heart failure with pneumonia, and seven cases with heart failure. Using LPOCUS, 75 cases were diagnosed with pneumonia and 12 cases with heart failure. The concordance rate between diagnosis by LPOCUS and clinical diagnosis was 87% (κ＝0.601, p<0.0001), which was good. The sensitivity of diagnosis of pneumonia was 99% for CT, 92% for X-ray, and 89% for LPOCUS. Specificity was highest for CT (85%), while LPOCUS and X-ray were 78%. The positive predictive value was 96% for CT, 95% for LPOCUS, and 93% for CXR, and the negative predictive value was 94% for CT, 74% for CXR, and 61% for LPOCUS. Conclusion: Bedside LPOCUS with a mobile US scanner was extremely useful for the diagnosis of pneumonia in the elderly.

Sarcoidosis is a granulomatous disease of unknown etiology that can vary from asymptomatic to life-threatening. It is a systemic disease that can affect any organ, including the liver. Because hepatic involvement is usually asymptomatic and cannot be depicted clearly on B-mode ultrasound images, it is often underdiagnosed. Here, we report a case of a patient with hepatic sarcoidosis that was diagnosed histologically by contrast-enhanced ultrasound-guided needle biopsy. Case report: A 78-year-old woman with pulmonary sarcoidosis and multiple hepatic nodules was admitted to our hospital for diagnosis of hepatic nodules. Dynamic contrast-enhanced computed tomography demonstrated multiple hypovascular nodules in the liver. These nodules could be recognized on contrast-enhanced ultrasound but could not be depicted clearly on B-mode ultrasound images. They were shown as a perfusion defect in the postvascular phase. Thus, contrast-enhanced ultrasound-guided needle biopsy was performed, and the patient was diagnosed with hepatic sarcoidosis. Due to insufficient staining with PAS-D, dysfunction of Kupffer cells in granuloma was speculated. This case report demonstrated that it is important to perform contrast-enhanced ultrasonography, and this can be the modality used to guide biopsy for patients with hepatic sarcoidosis if the hepatic lesions cannot be depicted on routine B-mode ultrasound images.