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Mindray introduced the new Resona I9 Elite Edition at ECR 2024 to complete its product range. Rachid Redouane, Product Manager of Ultrasound Imaging Systems Europe at Mindray, told Guido Gebhardt about the technology behind the system and its key features.

What are the challenges in ultrasound imaging of the liver?

The challenges lie primarily in the early quantification and differentiation of different stages of fatty liver disease, as conventional ultrasound methods can display the presence of fat but cannot determine its exact amount. The differentiation between simple steatosis and steatohepatitic change, which can lead to fibrosis and then cirrhosis, often requires invasive biopsies as imaging techniques reach their limits. There is also a need to further develop non-invasive and cost-effective imaging techniques that allow precise monitoring of disease progression and treatment success.

Rachid Redouane, Product Manager of Ultrasound Imaging Systems Europe at Mindray, presented the company’s new ultrasound system, Resona I-9 Elite Edition.

At ECR 2024, you launched an ultrasound system to detect fatty liver. What makes the equipment so special?

Our new ultrasound system has many key features. Number one is the zone scan technology ZST, which works entirely differentlythan the conventional scan technology of the other systems on the market. ZONE Sonography is a revolutionary, software-driven approach to acoustic data acquisition and image formation that breaks the barriers of conventional ultrasound imaging based on innovative channel data processing methods.

By using larger acoustic zones instead of line-by-line formation, our ZONE technology has the potential between 10 and 20 times more data per pixel than others. With retrospective focusing, we increase the spatial resolution, the tissue penetration, and decrease the noise

At the same time, the zone technology, with its ability to collect more data, allowed us to develop advanced tools and new features for the new Resona I9 Elite Edition.

With a completely new beam forming management, we dramatically improved the image quality of the B mode. We use a technology from our premium system, the color Doppler. This technology is called Ultra Micro Angiography (UMA).

What exactly does UMA do?

UMA uses plane wave technology to get more information with the slow flows and increase the spatial resolution. With UMA, we have a very sensitive color Doppler mode with very good penetration and a very high resolution. Doppler ultrasound assesses blood flow in the liver vessels, including the portal vein and hepatic arteries. This is important for the diagnosis of vascular diseases such as portal hypertension.

So that is the first key point with our system.

What about the second key point?

The second key point is our new package, the Fatty Liver Lab, with three multi-parametric imaging tools to enhance diagnostic confidence across a wide range of patients. Based on different acoustic technologies, the multi-parametric Fatty Liver Lab includes UltraSound ATtenuation (USAT) Analysis, HepatoRenal Index+(HRI+), and Liver Texture Index (LTI) that enables quantitative analysis of steatosis and improves the sensitivity of fatty liver detection in early stage.

The great thing about Mindray’s new Resona I-9 Elite is the zone scan technology. The device is also equipped with the Fatty Liver Lab, bringing high-end features to a mid-range ultrasound system.

Can you explain how these features work?

Mindray USAT provides a new and easy tool that obtains ultrasound attenuation imaging and measurement to analyze and diagnose fatty liver quantitatively. Accurate quality control indicators help users to obtain higher quality ultrasound attenuation images and measurements for easier screening, diagnosis, and follow-up of fatty liver disease.

Hepatorenal Index+ (HRI+) uses the ratio of the average echogenicity between liver and kidney cortex parenchyma to quantitatively evaluate the degree of hepatic steatosis. The more severe the fatty liver, the greater the HRI value. This measurement is based on Radio Frequency raw data and is not affected by the gain and display brightness.

Liver Texture Index (LTI) analyzes the statistical distributions of the Liver parenchyma Speckle, the random granular texture that obscures in ultrasound images, to get a score. The more severe the fatty liver, the higher the LTI value.

Is the new system specifically designed for a better fatty liver diagnosis?

Yes, exactly. We are focused on the liver parenchyma, looking at the texture, attenuation, and signal intensity.

The idea is that there is something very challenging about the future: we have a strong epidemia of liver disease. Fatty livers are increasing silently.

 Nonalcoholic fatty liver disease (NAFLD) has become one of the most prevalent chronic liver diseases in the world. The majority of chronic liver diseases are often unnoticeable and easily neglected, resulting in long-term irreversible damage. Therefore, the early detection of liver diseases and the monitoring and management of chronic liver disorders have become the focus of ongoing research in clinical practice. 

The next step, the Nonalcoholic Steatohepatitis (NASH), is the most severe form of NAFLD. NASH occurs when the fat buildup in the liver leads to inflammation (hepatitis) and scarring. NASH can be life-threatening, as it can cause liver scarring called cirrhosis or liver cancer. The incidence of fatty liver is increasing dramatically. According to the latest studies, we will expect dramatic growth in the years to come.

The earliest possible diagnosis is probably of great importance?

Yes. The idea is to detect fatty liver at a very early stage. This is the reason why this kind of complete portfolio is very important.

In addition, we are talking about multi-parametric imaging because, as I explained, we are looking at different acoustic technologies. The idea is to cross-reference information, not focusing on one direction but looking at three different directions and examining the correlation between the different information.

Our new system does not have a predecessor; it’s another system on top of what we presented last year. The Resona I9Elite is a new generation. 

The primary challenges of ultrasound imaging for the liver lie in early quantification and differentiation of different stages of fatty liver disease, particularly fatty liver imaging.

What makes the Resona I9 Elite so unique?

Our image processing method is unique. We use the ZONE Technology (ZST+) to increase the reliability and sensitivity of these tools.

So, we have premium performance in a compact design with advanced tools, which are taking advantage of our unique ZST+ technology.

With broad scanning segment (ZONE)  we go faster and collect more data per pixel increasing the reliability of our tools. In addition, with contrast-enhanced ultrasound (CEUS) the ZST+ technology,  enables to generate enhanced images with greater sensitivity of minor signals and longer duration of perfusion in tissue and organ examination.

What about the future of ultrasound imaging?

We believe that premium imaging coupled with advanced workflow technologies help ease clinicians’ increasing workload by offering intuitive and easy-to-use smart tools and AI-enhanced technologies to elevate clinician and patient satisfaction. The Resona I9 Elite offers today over 24 smart tools in various clinical applications, all with the goal of simplifying processes and instilling greater confidence in clinical decision-making.