Synthetic Elastography using B-mode Ultrasound through a Deep Fully-Convolutional Neural Network
Eindhoven University of Technology（埃因霍温理工大学）；University of Amsterdam（阿姆斯特丹大学）；University Hospital Hamburg-Eppendorf（汉堡-埃彭多夫大学医院）；Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas（圣保罗大学医学院临床医院）
R. R. Wildeboer, R. J. G. van Sloun, C. K. Mannaerts, P. H. Moraes, G. Salomon, M. C. Chammas, H. Wijkstra, M. Mischi
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发表信息：
IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control, 2020
Shear-wave elastography (SWE) permits local estimation of tissue elasticity, an important imaging marker in biomedicine. This recently-developed, advanced technique assesses the speed of a laterally-travelling shear wave after an acoustic radiation force "push" to estimate local Young's moduli in an operator-independent fashion. In this work, we show how synthetic SWE (sSWE) images can be generated based on conventional B-mode imaging through deep learning. Using side-by-side-view B-mode/SWE images collected in 50 patients with prostate cancer, we show that sSWE images with a pixel-wise mean absolute error of 4.5+/-0.96 kPa with regard to the original SWE can be generated. Visualization of high-level feature levels through t-Distributed Stochastic Neighbor Embedding reveals substantial overlap between data from two different scanners. Qualitatively, we examined the use of the sSWE methodology for B-mode images obtained with a scanner without SWE functionality. We also examined the use of this type of network in elasticity imaging in the thyroid. Limitations of the technique reside in the fact that networks have to be retrained for different organs, and that the method requires standardization of the imaging settings and procedure. Future research will be aimed at development of sSWE as an elasticity-related tissue typing strategy that is solely based on B-mode ultrasound acquisition, and the examination of its clinical utility.
University of Montreal Hospital Research Center (CRCHUM)（蒙特利尔大学医院研究中心）；University of California, Los Angeles（加利福尼亚大学洛杉矶分校）；California Nanosystems Institute（加州纳米系统研究所）
It is known that changes in the mechanical properties of tissues are associated with the onset and progression of certain diseases. Ultrasound elastography is a technique to characterize tissue stiffness using ultrasound imaging either by measuring tissue strain using quasi-static elastography or natural organ pulsation elastography, or by tracing a propagated shear wave induced by a source or a natural vibration using dynamic elastography. In recent years, deep learning has begun to emerge in ultrasound elastography research. In this review, several common deep learning frameworks in the comp…
Displacement estimation is very important in ultrasound elastography and failing to estimate displacement correctly results in failure in generating strain images. As conventional ultrasound elastography techniques suffer from decorrelation noise, they are prone to fail in estimating displacement between echo signals obtained during tissue distortions. This study proposes a novel elastography technique which addresses the decorrelation in estimating displacement field. We call our method GLUENet (GLobal Ultrasound Elastography Network) which uses deep Convolutional Neural Network (CNN) to get …
Do We Need Pre-Processing for Deep Learning Based Ultrasound Shear Wave Elastography?
Hamburg University of Technology（汉堡工业大学）；Institute of Medical Technology and Intelligent Systems（医学技术与智能系统研究所）；SustAInLivWork Center of Excellence（SustAInLivWork卓越中心）
Shenzhen Research Institute of Big Data, the Chinese University of Hong Kong（香港中文大学深圳大数据研究院）；Huazhong University of Science and Technology（华中科技大学）；Shenzhen Third People’s Hospital（深圳市第三人民医院）
With the development of radiomics, noninvasive diagnosis like ultrasound (US) imaging plays a very important role in automatic liver fibrosis diagnosis (ALFD). Due to the noisy data, expensive annotations of US images, the application of Artificial Intelligence (AI) assisting approaches encounters a bottleneck. Besides, the use of mono-modal US data limits the further improve of the classification results. In this work, we innovatively propose a multi-modal fusion network with active learning (MMFN-AL) for ALFD to exploit the information of multiple modalities, eliminate the noisy data and red…
Displacement estimation is a critical step of virtually all Ultrasound Elastography (USE) techniques. Two main features make this task unique compared to the general optical flow problem: the high-frequency nature of ultrasound radio-frequency (RF) data and the governing laws of physics on the displacement field. Recently, the architecture of the optical flow networks has been modified to be able to use RF data. Also, semi-supervised and unsupervised techniques have been employed for USE by considering prior knowledge of displacement continuity in the form of the first- and second-derivative r…
Ultrasound elastography is an emerging noninvasive imaging technique wherein pathological alterations can be visualized by revealing the mechanical properties of the tissue. Estimating tissue displacement in all directions is required to accurately estimate the mechanical properties. Despite capabilities of elastography techniques in estimating displacement in both axial and lateral directions, estimation of axial displacement is more accurate than lateral direction due to higher sampling frequency, higher resolution and having a carrier signal propagating in the axial direction. Among differe…
Ultrasound elasticity images which enable the visualization of quantitative maps of tissue stiffness can be reconstructed by solving an inverse problem. Classical model-based approaches for ultrasound elastography use deterministic finite element methods (FEMs) to incorporate the governing physical laws resulting in poor performance in noisy conditions. Moreover, these approaches utilize fixed regularizers for various tissue patterns while appropriate data-adaptive priors might be required for capturing the complex spatial elasticity distribution. In this regard, we propose a joint model-based…
Convolutional Neural Networks (CNN) have been found to have great potential in optical flow problems thanks to an abundance of data available for training a deep network. The displacement estimation step in UltraSound Elastography (USE) can be viewed as an optical flow problem. Despite the high performance of CNNs in optical flow, they have been rarely used for USE due to unique challenges that both input and output of USE networks impose. Ultrasound data has much higher high-frequency content compared to natural images. The outputs are also drastically different, where displacement values in …
This paper introduces a novel technique to estimate tissue displacement in quasi-static elastography. A major challenge in elastography is estimation of displacement (also referred to time-delay estimation) between pre-compressed and post-compressed ultrasound data. Maximizing normalized cross correlation (NCC) of ultrasound radio-frequency (RF) data of the pre- and post-compressed images is a popular technique for strain estimation due to its simplicity and computational efficiency. Several papers have been published to increase the accuracy and quality of displacement estimation based on NCC…
Energy-based ultrasound elastography techniques minimize a regularized cost function consisting of data and continuity terms to obtain local displacement estimates based on the local time-delay estimation (TDE) between radio-frequency (RF) frames. The data term associated with the existing techniques takes only the amplitude similarity into account and hence is not sufficiently robust to the outlier samples present in the RF frames under consideration. This drawback creates noticeable artifacts in the strain image. To resolve this issue, we propose to formulate the data function as a linear co…
Quasi-static ultrasound elastography (USE) is an imaging modality that consists of determining a measure of deformation (i.e.strain) of soft tissue in response to an applied mechanical force. The strain is generally determined by estimating the displacement between successive ultrasound frames acquired before and after applying manual compression. The computational efficiency and accuracy of the displacement prediction, also known as time-delay estimation, are key challenges for real-time USE applications. In this paper, we present a novel deep-learning method for efficient time-delay estimati…
Time delay estimation (TDE) is a critical and challenging step in all ultrasound elastography methods. A growing number of TDE techniques require an approximate but robust and fast method to initialize solving for TDE. Herein, we present a fast method for calculating an approximate TDE between two radio frequency (RF) frames of ultrasound. Although this approximate TDE can be useful for several algorithms, we focus on GLobal Ultrasound Elastography (GLUE), which currently relies on Dynamic Programming (DP) to provide this approximate TDE. We exploit Principal Component Analysis (PCA) to find t…
Model-based computational elasticity imaging of tissues can be posed as solving an inverse problem over finite elements spanning the displacement image. As most existing quasi-static elastography methods count on deterministic formulations of the forward model resulting in a constrained optimization problem, the impact of displacement observation errors has not been well addressed. To this end, we propose a new statistical technique that leads to a unified optimization problem for elasticity imaging. Our statistical model takes the imperfect nature of the displacement measurements into account…
Computer-aided detection (CAD) of benign and malignant breast lesions becomes increasingly essential in breast ultrasound (US) imaging. The CAD systems rely on imaging features identified by the medical experts for their performance, whereas deep learning (DL) methods automatically extract features from the data. The challenge of the DL is the insufficiency of breast US images available to train the DL models. Here, we present an ensemble transfer learning model to classify benign and malignant breast tumors using B-mode breast US (B-US) and strain elastography breast US (SE-US) images. This m…
The performance of ultrasound elastography (USE) heavily depends on the accuracy of displacement estimation. Recently, Convolutional Neural Networks (CNN) have shown promising performance in optical flow estimation and have been adopted for USE displacement estimation. Networks trained on computer vision images are not optimized for USE displacement estimation since there is a large gap between the computer vision images and the high-frequency Radio Frequency (RF) ultrasound data. Many researchers tried to adopt the optical flow CNNs to USE by applying transfer learning to improve the performa…
Concordia University（康考迪亚大学）；University of Montreal（蒙特利尔大学）
Ultrasound elastography is used to estimate the mechanical properties of the tissue by monitoring its response to an internal or external force. Different levels of deformation are obtained from different tissue types depending on their mechanical properties, where stiffer tissues deform less. Given two radio frequency (RF) frames collected before and after some deformation, we estimate displacement and strain images by comparing the RF frames. The quality of the strain image is dependent on the type of motion that occurs during deformation. In-plane axial motion results in high-quality strain…
Time delay estimation (TDE) between two radio-frequency (RF) frames is one of the major steps of quasi-static ultrasound elastography, which detects tissue pathology by estimating its mechanical properties. Regularized optimization-based techniques, a prominent class of TDE algorithms, optimize a non-linear energy functional consisting of data constancy and spatial continuity constraints to obtain the displacement and strain maps between the time-series frames under consideration. The existing optimization-based TDE methods often consider the L2-norm of displacement derivatives to construct th…
Ultrasound Elastography aims to determine the mechanical properties of the tissue by monitoring tissue deformation due to internal or external forces. Tissue deformations are estimated from ultrasound radio frequency (RF) signals and are often referred to as time delay estimation (TDE). Given two RF frames I1 and I2, we can compute a displacement image which shows the change in the position of each sample in I1 to a new position in I2. Two important challenges in TDE include high computational complexity and the difficulty in choosing suitable RF frames. Selecting suitable frames is of high im…
Objective: Strain elastography and shear wave elastography are two commonly used methods to quantify cervical elasticity; however, they have limitations. Strain elastography is effective in showing tissue elasticity distribution in a single image, but the absence of stress information causes difficulty in comparing the results acquired from different imaging sessions. Shear wave elastography is effective in measuring shear wave speed (an intrinsic tissue property correlated with elasticity) in relatively homogeneous tissue, such as in the liver. However, for inhomogeneous tissue in the cervix,…
Ultrasound elastography estimates the mechanical properties of the tissue from two Radio-Frequency (RF) frames collected before and after tissue deformation due to an external or internal force. This work focuses on strain imaging in quasi-static elastography, where the tissue undergoes slow deformations and strain images are estimated as a surrogate for elasticity modulus. The quality of the strain image depends heavily on the underlying deformation, and even the best strain estimation algorithms cannot estimate a good strain image if the underlying deformation is not suitable. Herein, we int…
Convolutional Neural Networks (CNN) have shown promising results for displacement estimation in UltraSound Elastography (USE). Many modifications have been proposed to improve the displacement estimation of CNNs for USE in the axial direction. However, the lateral strain, which is essential in several downstream tasks such as the inverse problem of elasticity imaging, remains a challenge. The lateral strain estimation is complicated since the motion and the sampling frequency in this direction are substantially lower than the axial one, and a lack of carrier signal in this direction. In comput…
Department of Internal medicine, National Taiwan University（台湾大学医学院）；department of medicine, national Taiwan University（台湾大学医学院）；department of internal medicine, National Taiwan University Hospital（台湾大学医学院附设医院）；department of medicine, National Taiwan University Cancer center（台湾大学医学院癌症中心）
The purpose of this study is to differentiate malignant and benign mediastinal lesions by using the three-dimensional convolutional neural network through the endobronchial ultrasound (EBUS) image. Compared with previous study, our proposed model is robust to noise and able to fuse various imaging features and spatiotemporal features of EBUS videos. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic tool for intrathoracic lymph nodes. Physician can observe the characteristics of the lesion using grayscale mode, doppler mode, and elastography during the…
Ultrasound elastography is the method to image the elasticity of compliant tissues due to a mechanical compression applied to it. In elastography, the local strain of explored tissue is estimated by analyzing the echo signals. This is accomplished by a sonographer who uses ultrasound transducer to apply pressure on the tissue area causing displacement of the tissue. A set of data is obtained before and after the compression. This stress along the axial direction not only causes deformation in that direction but it can also cause lateral deformation in the tissue. This relative deformation is l…
Mechanical properties of tissue provide valuable information for identifying lesions. One approach to obtain quantitative estimates of elastic properties is shear wave elastography with optical coherence elastography (OCE). However, given the shear wave velocity, it is still difficult to estimate elastic properties. Hence, we propose deep learning to directly predict elastic tissue properties from OCE data. We acquire 2D images with a frame rate of 30 kHz and use convolutional neural networks to predict gelatin concentration, which we use as a surrogate for tissue elasticity. We compare our de…
École polytechnique fédérale de Lausanne（洛桑联邦理工学院）；University Hospital Center (CHUV)（大学医院中心（CHUV））；University of Lausanne（洛桑大学）；Center for Biomedical Imaging (CIBM)（生物医学成像中心（CIBM））
Thanks to its capability of acquiring full-view frames at multiple kilohertz, ultrafast ultrasound imaging unlocked the analysis of rapidly changing physical phenomena in the human body, with pioneering applications such as ultrasensitive flow imaging in the cardiovascular system or shear-wave elastography. The accuracy achievable with these motion estimation techniques is strongly contingent upon two contradictory requirements: a high quality of consecutive frames and a high frame rate. Indeed, the image quality can usually be improved by increasing the number of steered ultrafast acquisition…
University of Malaya（马来亚大学）；University of Tehran（德黑兰大学）
Reliable classification of benign and malignant lesions in breast ultrasound images can provide an effective and relatively low cost method for early diagnosis of breast cancer. The accuracy of the diagnosis is however highly dependent on the quality of the ultrasound systems and the experience of the users (radiologists). The leverage in deep convolutional neural network approaches provided solutions in efficient analysis of breast ultrasound images. In this study, we proposed a new framework for classification of breast cancer lesions by use of an attention module in modified VGG16 architect…
The objective of this study is the segmentation of the intima-media complex of the common carotid artery, on longitudinal ultrasound images, to measure its thickness. We propose a fully automatic region-based segmentation method, involving a supervised region-based deep-learning approach based on a dilated U-net network. It was trained and evaluated using a 5-fold cross-validation on a multicenter database composed of 2176 images annotated by two experts. The resulting mean absolute difference (<120 um) compared to reference annotations was less than the inter-observer variability (180 um). Wi…
One of the routine examinations that are used for prenatal care in many countries is ultrasound imaging. This procedure provides various information about fetus health and development, the progress of the pregnancy and, the baby's due date. Some of the biometric parameters of the fetus, like fetal head circumference (HC), must be measured to check the fetus's health and growth. In this paper, we investigated the effects of using multi-scale inputs in the network. We also propose a light convolutional neural network for automatic HC measurement. Experimental results on an ultrasound dataset of …
In this work we propose to segment the prostate on a challenging dataset of trans-rectal ultrasound (TRUS) images using convolutional neural networks (CNNs) and statistical shape models (SSMs). TRUS is commonly used for a number of image-guided interventions on the prostate. Fast and accurate segmentation on the organ in these images is crucial to planning and fusion with other modalities such as magnetic resonance images (MRIs) . However, TRUS has limited soft tissue contrast and signal to noise ratio which makes the task of segmenting the prostate challenging and subject to inter-observer an…
Simulation-based ultrasound training can be an essential educational tool. Realistic ultrasound image appearance with typical speckle texture can be modeled as convolution of a point spread function with point scatterers representing tissue microstructure. Such scatterer distribution, however, is in general not known and its estimation for a given tissue type is fundamentally an ill-posed inverse problem. In this paper, we demonstrate a convolutional neural network approach for probabilistic scatterer estimation from observed ultrasound data. We herein propose to impose a known statistical dis…
NRP Co.（NRP公司）；Tarbiat Modares University（塔比阿特莫达勒斯大学）；AJA University of Medical Science（AJA医科大学）；Neshat Physical Medicine and Rehabilitation Center（内沙特物理医学与康复中心）
Tendon injuries like tendinopathies, full and partial thickness tears are prevalent, and the supraspinatus tendon (SST) is the most vulnerable ones in the rotator cuff. Early diagnosis of SST tendinopathies is of high importance and hard to achieve using ultrasound imaging. In this paper, an automatic tendinopathy recognition framework based on convolutional neural networks has been proposed to assist the diagnosis. This framework has two essential parts of tendon segmentation and classification. Tendon segmentation is done through a novel network, NASUNet, which follows an encoder-decoder arc…
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford（牛津大学工程科学系生物医学工程研究所）；Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford（牛津大学约翰拉德克利夫医院妇产科）；Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford（牛津大学李兆基健康信息与发现中心大数据研究所）
To improve the performance of most neuroimiage analysis pipelines, brain extraction is used as a fundamental first step in the image processing. But in the case of fetal brain development, there is a need for a reliable US-specific tool. In this work we propose a fully automated 3D CNN approach to fetal brain extraction from 3D US clinical volumes with minimal preprocessing. Our method accurately and reliably extracts the brain regardless of the large data variation inherent in this imaging modality. It also performs consistently throughout a gestational age range between 14 and 31 weeks, rega…
Polycystic Ovary Syndrome (PCOS) is an endrocrinological dysfunction prevalent among women of reproductive age. PCOS is a combination of syndromes caused by an excess of androgens - a group of sex hormones - in women. Syndromes including acne, alopecia, hirsutism, hyperandrogenaemia, oligo-ovulation, etc. are caused by PCOS. It is also a major cause of female infertility. An estimated 15% of reproductive-aged women are affected by PCOS globally. The necessity of detecting PCOS early due to the severity of its deleterious effects cannot be overstated. In this paper, we have developed PCONet - a…
Medical University of Warsaw（华沙医科大学）；University of Warsaw（华沙大学）；SGH Warsaw School of Economics（SGH华沙经济学院）；Carolina Medical Center（卡罗莱纳医疗中心）；Warsaw University of Technology（华沙理工大学）；Tooploox
Achilles tendon rupture is a debilitating injury, which is typically treated with surgical repair and long-term rehabilitation. The recovery, however, is protracted and often incomplete. Diagnosis, as well as healing progress assessment, are largely based on ultrasound and magnetic resonance imaging. In this paper, we propose an automatic method based on deep learning for analysis of Achilles tendon condition and estimation of its healing progress on ultrasound images. We develop custom convolutional neural networks for classification and regression on healing score and feature extraction. Our…
School of Biomedical Engineering, Southern Medical University（南方医科大学生物医学工程学院）
Breast ultrasound (BUS) image segmentation plays a crucial role in a computer-aided diagnosis system, which is regarded as a useful tool to help increase the accuracy of breast cancer diagnosis. Recently, many deep learning methods have been developed for segmentation of BUS image and show some advantages compared with conventional region-, model-, and traditional learning-based methods. However, previous deep learning methods typically use skip-connection to concatenate the encoder and decoder, which might not make full fusion of coarse-to-fine features from encoder and decoder. Since the str…
B-mode ultrasound tongue imaging is widely used in the speech production field. However, efficient interpretation is in a great need for the tongue image sequences. Inspired by the recent success of unsupervised deep learning approach, we explore unsupervised convolutional network architecture for the feature extraction in the ultrasound tongue image, which can be helpful for the clinical linguist and phonetics. By quantitative comparison between different unsupervised feature extraction approaches, the denoising convolutional autoencoder (DCAE)-based method outperforms the other feature extra…
Non-invasive vascular elastography is an emerging technique in vascular tissue imaging. During the past decades, several techniques have been suggested to estimate the tissue elasticity by measuring the displacement of the Carotid vessel wall. Cross correlation-based methods are the most prevalent approaches to measure the strain exerted in the wall vessel by the blood pressure. In the case of a low pressure, the displacement is too small to be apparent in ultrasound imaging, especially in the regions far from the center of the vessel, causing a high error of displacement measurement. On the o…
Stony Brook University（石溪大学）；City University of New York at CSI（纽约市立大学斯塔滕岛学院）；Southern Medical University（南方医科大学）；University of Texas Southwestern Medical Centre（德克萨斯大学西南医学中心）；The Fourth Medical University（第四医科大学）；University of Wisconsin（威斯康星大学）
The elasticity of soft tissues has been widely considered as a characteristic property to differentiate between healthy and vicious tissues and, therefore, motivated several elasticity imaging modalities, such as Ultrasound Elastography, Magnetic Resonance Elastography, and Optical Coherence Elastography. This paper proposes an alternative approach of modeling the elasticity using Computed Tomography (CT) imaging modality for model-based feature extraction machine learning (ML) differentiation of lesions. The model describes a dynamic non-rigid (or elastic) deformation in differential manifold…
Objective: To test automated in vivo estimation of active and passive skeletal muscle states using ultrasonic imaging. Background: Current technology (electromyography, dynamometry, shear wave imaging) provides no general, non-invasive method for online estimation of skeletal intramuscular states. Ultrasound (US) allows non-invasive imaging of muscle, yet current computational approaches have never achieved simultaneous extraction nor generalisation of independently varying, active and passive states. We use deep learning to investigate the generalizable content of 2D US muscle images. Method:…
While accuracy is an evident criterion for ultrasound image segmentation, output consistency across different tests is equally crucial for tracking changes in regions of interest in applications such as monitoring the patients' response to treatment, measuring the progression or regression of the disease, reaching a diagnosis, or treatment planning. Convolutional neural networks (CNNs) have attracted rapidly growing interest in automatic ultrasound image segmentation recently. However, CNNs are not shift-equivariant, meaning that if the input translates, e.g., in the lateral direction by one p…
Johns Hopkins University（约翰斯·霍普金斯大学）；University of British Columbia（不列颠哥伦比亚大学）
Due to imaging artifacts and low signal-to-noise ratio in ultrasound images, automatic bone surface segmentation networks often produce fragmented predictions that can hinder the success of ultrasound-guided computer-assisted surgical procedures. Existing pixel-wise predictions often fail to capture the accurate topology of bone tissues due to a lack of supervision to enforce connectivity. In this work, we propose an orientation-guided graph convolutional network to improve connectivity while segmenting the bone surface. We also propose an additional supervision on the orientation of the bone …
A method is proposed for converting raw ultrasound signals of respiratory organ motion into high frame rate dynamic MRI using a long-term recurrent convolutional neural network. Ultrasound signals were acquired using a single-element transducer, referred to here as `organ-configuration motion' (OCM) sensor, while sagittal MR images were simultaneously acquired. Both streams of data were used for training a cascade of convolutional layers, to extract relevant features from raw ultrasound, followed by a recurrent neural network, to learn its temporal dynamics. The network was trained with MR ima…
Ultrafast ultrasound imaging remains an active area of interest in the ultrasound community due to its ultra-high frame rates. Recently, a wide variety of studies based on deep learning have sought to improve ultrafast ultrasound imaging. Most of these approaches have been performed on radio frequency (RF) signals. However, inphase/quadrature (I/Q) digital beamformers are now widely used as low-cost strategies. In this work, we used complex convolutional neural networks for reconstruction of ultrasound images from I/Q signals. We recently described a convolutional neural network architecture c…
We propose a three-dimensional (3D) multimodal medical imaging system that combines freehand ultrasound and structured light 3D reconstruction in a single coordinate system without requiring registration. To the best of our knowledge, these techniques have not been combined before as a multimodal imaging technique. The system complements the internal 3D information acquired with ultrasound, with the external surface measured with the structure light technique. Moreover, the ultrasound probe's optical tracking for pose estimation was implemented based on a convolutional neural network. Experime…
Image-guided radiation therapy can benefit from accurate motion tracking by ultrasound imaging, in order to minimize treatment margins and radiate moving anatomical targets, e.g., due to breathing. One way to formulate this tracking problem is the automatic localization of given tracked anatomical landmarks throughout a temporal ultrasound sequence. For this, we herein propose a fully-convolutional Siamese network that learns the similarity between pairs of image regions containing the same landmark. Accordingly, it learns to localize and thus track arbitrary image features, not only predefine…
