Tissue characterization using fractal dimension of high frequency ultrasound RF time series

This paper is the first report on the analysis of ultrasound RF echo time series acquired using high frequency ultrasound. We show that variations in the intensity of one sample of RF echo over time is correlated with tissue microstructure. To form the RF time series, a high frequency probe and a tissue sample were fixed in position and RF signals backscattered from the tissue were continuously recorded. The fractal dimension of RF time series was used as a feature for tissue classification. Feature values acquired from different areas of one tissue type were statistically similar. For animal tissues with different cellular microstructure, we successfully used the fractal dimension of RF time series to distinguish segments as small as 20 microns with accuracies as high as 98%. The results of this study demonstrate that the analysis of RF time series is a promising approach for distinguishing tissue types with different cellular microstructure.

Reconstructions of shear modulus, Poisson's ratio, and density using approximate mean normal stress lambda epsilon alpha alpha as unknown

As a differential diagnosis technique for living soft tissues, we are developing ultrasonic-strain-measurement-based shear modulus reconstruction methods. Previously, we reported three-dimensional (3-D) and 2-D reconstruction methods utilizing a typical Poisson's ratio very close to 0.5 (nearly-incompressible). However, because a decrease in the accuracy of the reconstructed value was confirmed to be due to the difference between the original value and the set value, we proposed 3-D and 2-D methods of reconstructing Poisson's ratio as well. Furthermore, we proposed methods of reconstructing density and dealing with dynamic deformation. However, due to tissue incompressibility, the reconstructions of shear modulus, Poisson's ratio, and density became unstable. In this report, to obtain stable, unique reconstructions, we describe a new reconstruction method using mean normal stress approximated by the product of one of Lame's constants X and volume strain epsilon alpha alpha as an unknown. Regularization is simultaneously applied to the respective distributions to decrease the instability of the reconstructions due to measurement errors of the deformation. This method also enables stable, unique reconstructions of shear modulus and density under the condition that the mean normal stress remains unknown. We also verify the effectiveness of this method through 3-D simulations, while showing erroneous artifacts occurring when 2-D and 1-D reconstructions are performed.

Basic nonlinear acoustics: an introduction for radiological physicists

Presented is a brief introduction to nonlinear acoustics, a topic of increasing importance in modern diagnostic ultrasound. Specifically treated is shock wave and harmonic production in lossless media. We also present a description of linear attenuation mechanisms in soft tissue and finally nonlinear propagation in soft tissue.

Dynamic mechanical response of elastic spherical inclusions to impulsive acoustic radiation force excitation

Acoustic radiation force impulse imaging has been used clinically to study the dynamic response of lesions relative to their background material to focused, impulsive acoustic radiation force excitations through the generation of dynamic displacement field images. Dynamic displacement data are typically displayed as a set of parametric images, including displacement immediately after excitation, maximum displacement, time to peak displacement, and recovery time from peak displacement. To date, however, no definitive trends have been established between these parametric images and the tissues' mechanical properties. This work demonstrates that displacement magnitude, time to peak displacement, and recovery time are all inversely related to the Young's modulus in homogeneous elastic media. Experimentally, pulse repetition frequency during displacement tracking limits stiffness resolution using the time to peak displacement parameter. The excitation pulse duration also impacts the time to peak parameter, with longer pulses reducing the inertial effects present during impulsive excitations. Material density affects tissue dynamics, but is not expected to play a significant role in biological tissues. The presence of an elastic spherical inclusion in the imaged medium significantly alters the tissue dynamics in response to impulsive, focused acoustic radiation force excitations. Times to peak displacement for excitations within and outside an elastic inclusion are still indicative of local material stiffness; however, recovery times are altered due to the reflection and transmission of shear waves at the inclusion boundaries. These shear wave interactions cause stiffer inclusions to appear to be displaced longer than the more compliant background material. The magnitude of shear waves reflected at elastic lesion boundaries is dependent on the stiffness contrast between the inclusion and the background material, and the stiffness and size of the inclusion dictate when shear wave reflections within the lesion will interfere with one another. Jitter and bias associated with the ultrasonic displacement tracking also impact the estimation of a tissue's dynamic response to acoustic radiation force excitation.

The membranous layer of superficial fascia: evidence for its widespread distribution in the body

A discrete membranous layer, "stratum membranosum", in human subcutaneous tissue is classically described as confined to the lower anterior abdominal wall and perineum and referred to as Scarpa's and Colles' fasciae, respectively. Evidence for its existence elsewhere in the body is scanty and therefore the present study was undertaken. Dissection of six embalmed adult cadavers, along with ultrasound imaging on four living subjects, were carried out to determine the existence, topography, and thickness of the membranous layer of superficial fascia in different regions of the body. In all six cadavers, a continuous layer of fibrous membrane in the superficial fascia was found consistently in all the dissected regions of the body and was also confirmed by ultrasonography. The arrangement and thickness of this membranous layer varied according to body region, body surface, and gender. It was thicker in the lower than in the upper extremity, on the posterior than anterior aspect of the body, and in females than in males. The mean thickness of the membranous layer ranged from 39 to 189 mum, being thickest in the leg and thinnest over the dorsum of the hand. The membranous layer was observed to have two or even three components in regions such as the breast, back, thigh, and arm and was seen to split, forming special compartments around subcutaneous major veins of upper and lower extremities, with fibrous septa extending to attach to the vessel wall. Functionally, the membranous superficial fascia may play a role in the integrity of the skin and support for subcutaneous structures particularly veins, by ensuring their patency. Understanding the topographic anatomy of this fascial layer may help explain body-contour deformities and provide the anatomic basis for surgical correction.

Effect of umbilical ring constriction on Wharton's jelly

OBJECTIVE

The turgor of Wharton's jelly depends on osmotic and hydrostatic pressures. We tested the hypothesis that umbilical ring constriction has an impact on umbilical venous hemodynamics and thus on the volume of Wharton's jelly.

METHODS

In a cross-sectional study of 237 low-risk singleton pregnancies, the cross-sectional area of the fetal end of the umbilical cord was determined using sonography at 20-41 weeks of gestation. The inner area of the two arteries and the vein was also measured and subtracted from the cord area to calculate the area of Wharton's jelly. Based on the Bernoulli equation, the degree of vein constriction at the umbilical ring was assessed using the blood velocity increment at the abdominal inlet. Regression analysis and SD-score statistics were used to construct mean values and to assess the effects. The dataset was also analyzed for gender-specific effects.

RESULTS

The umbilical cord cross-sectional area increased with gestational age during the period 20-31 weeks, remaining essentially stable thereafter. The Wharton's jelly increased with gestational age from 20 until 31-32 weeks of gestation and remained at the same level for the rest of the pregnancy. At mid-gestation, on average 70% of the cord cross-sectional area was occupied by Wharton's jelly; at 31 weeks and later this value was 60%. Umbilical vein constriction was associated with reduced umbilical cord cross-sectional area and Wharton's jelly in female fetuses (P = 0.0007 and P = 0.003, respectively), but not in male fetuses.

CONCLUSIONS

Under physiological conditions, umbilical ring constriction affects umbilical vein hemodynamics, with corresponding effects on the umbilical cord cross-sectional area and the amount of Wharton's jelly. Interestingly, the effects are gender-specific.

High-resolution ultrasound analysis of subsynovial connective tissue in human cadaver carpal tunnel

The carpal tunnel contains the median nerve, nine flexor tendons, two synovial bursae, and peritendinous subsynovial connective tissue (SSCT). Fibrosis of the SSCT is the most consistent pathological finding in patients with carpal tunnel syndrome. We investigated the anatomy and gliding characteristics of the flexor digitorum superficialis tendon and its adjacent SSCT with high-resolution ultrasound (15 MHz). Our hypotheses were that tendon and SSCT are distinguishable by ultrasound and that their velocities during tendon excursion are different. Qualitative ultrasound analysis of a flexor tendon and its SSCT was performed on five cadaver wrists and correlated to respective findings after anatomical study of the same cadavers. Quantitative Doppler velocity analysis of eight cadaver wrists was done to assess the sliding movement of the tendon and its SSCT within the carpal tunnel. No significant difference was found between the thickness of SSCT measured by ultrasound and that measured directly after dissection. The SSCT moved slower than its flexor tendon. The SSCT velocities were statistically different from the tendon velocities (t-test, p>0.001). High-resolution ultrasound is a very precise method to display the anatomy of the tendon and SSCT within the carpal tunnel, and their different velocities can be detected with Doppler. Noninvasive assessment of the thickness and velocity of the tenosynovium in carpal tunnel syndrome by high-resolution sonography might be a new diagnostic tool for disorders affecting the SSCT, especially carpal tunnel syndrome.

A micro-tomography method based on X-ray diffraction enhanced imaging for the visualization of micro-organs and soft tissues

Diffraction enhanced imaging (DEI) is one of the phase contrast imaging methods using the monochromatic X-ray from synchrotron, which provides information on the out-of-plane angular deviation of X-ray. DEI allows the investigation of micro-structures inside weakly absorbing samples at high spatial resolution without serious radiation exposure. Tomographic techniques can be applied readily to phase contrast images. The combination of DEI and tomography allows for a reconstruction of refractive index gradient distribution inside weakly absorbing samples with micrometer resolution, particularly suited for the 3D observation of micro-organisms and tissues. The existing phase contrast tomography methods based on DEI use phase contrast images as projections, such images contain not only the phase information, but also the absorption information. A novel method (DEI in the tomography mode) was developed to greatly increase the proportion of refraction information in phase contrast images by computing the difference between the two sets of images acquired at different angles of the rocking curve to adopt the projections with a complete set (2pi) for reconstruction. The reconstructed images of cochlea of a guinea pig showed the spatial structures and the micro-features inside the samples. The new method reveals higher spatial resolution compared to the conventional phase contrast tomography methods and is more suitable to the investigation of micro-structures of micro-organisms and tissue materials.

Segmentation methodology for automated classification and differentiation of soft tissues in multiband images of high-resolution ultrasonic transmission tomography

This paper presents a novel segmentation methodology for automated classification and differentiation of soft tissues using multiband data obtained with the newly developed system of high-resolution ultrasonic transmission tomography (HUTT) for imaging biological organs. This methodology extends and combines two existing approaches: the L-level set active contour (AC) segmentation approach and the agglomerative hierarchical kappa-means approach for unsupervised clustering (UC). To prevent the trapping of the current iterative minimization AC algorithm in a local minimum, we introduce a multiresolution approach that applies the level set functions at successively increasing resolutions of the image data. The resulting AC clusters are subsequently rearranged by the UC algorithm that seeks the optimal set of clusters yielding the minimum within-cluster distances in the feature space. The presented results from Monte Carlo simulations and experimental animal-tissue data demonstrate that the proposed methodology outperforms other existing methods without depending on heuristic parameters and provides a reliable means for soft tissue differentiation in HUTT images.

A simple viscoelastic model for soft tissues in the frequency range 6-20 MHz

In this paper, we present measurements of the shear properties of porcine skeletal muscle, liver, and kidney and a novel model describing them. Following a previously used method, shear mechanical impedances are measured, and complex shear moduli are obtained in the frequency range 6-20 MHz. As indicated in previous results, negative storage moduli are obtained in some measurements, which yield negative shear moduli in traditional linear viscoelastic models such as the Maxwell model, the Voigt model, and the Kelvin model. To resolve this problem, we propose a simple extension of the Voigt model. A mass is introduced into the model to account for the extra phase shift that apparently produces the negative moduli, and the shear stress thereby is related to the inertia of the material. The observed negative storage moduli are predicted by the new model when the relaxation time of the material is large and the working frequency is high. The model is fitted to experimental data to obtain values for material constants.

The stiffening of arteries by the tissue-mimicking gelatin

Pulse wave velocity (PWV) is widely used for estimating the stiffness of an artery. PWV is measured by the time of travel of the "foot" of the pressure wave over a known distance. This technique has a low time resolution and is an average measurement of artery stiffness between the two measuring sites. The elastic modulus of the artery can be estimated with PWV, but the surrounding tissue effects are not considered. In this paper an external short pulse wave is generated noninvasively in the arterial wall by the radiation force of ultrasound. The pulse wave velocity in the artery is measured by a scanning technique with high-time resolution. The effect of tissue-mimicking gelatin on the artery is analyzed by measuring the wave velocity of the artery without and embedded in gelatin. It is found that the tissue-mimicking gelatin significantly stiffens the rubber tube and the artery if they are embedded in gelatin.

Tissue Doppler Assessment of Ventricular Function during Cycling in 7- to 12-yr-old Boys

PURPOSE

Studies utilizing submaximal supine exercise have indicated that tissue Doppler imaging (TDI) may be useful for assessing ventricular systolic and diastolic function during exercise and might offer a means of detecting patients with early myocardial dysfunction. This investigation of 14 healthy boys ages 7-12 yr was designed to assess measures of inotropic and lusitropic function during maximal upright cycle exercise.

METHODS

Color tissue Doppler imaging (S and E' waves, indicative of systolic and diastolic function, respectively), stroke volume, and mitral peak inflow velocity (E wave) were recorded at rest and during a progressive upright cycle test to exhaustion.

RESULTS

Values of TDI-S and TDI-E' were obtained at exhaustive exercise in all but one subject. Mean value of S rose 163% (3.8+/-1.2 to 10.0+/-2.5 cm.s), and average E' increased by 92% (-6.3+/-2.2 to -12.1+/-3.2 cm.s). No significant changes were observed in the ratio of E' to mitral peak flow velocity (E), suggesting that left ventricular end-diastolic pressure remained stable.

CONCLUSIONS

These data indicate that measurement of TDI is feasible during maximal upright exercise, and velocities obtained may provide insights into ventricular systolic and diastolic functional capacity.

Sonoelastographic imaging of interference patterns for estimation of shear velocity distribution in biomaterials

The authors have recently demonstrated the shear wave interference patterns created by two coherent vibration sources imaged with the vibration sonoelastography technique. If the two sources vibrate at slightly different frequencies omega and omega+deltaomega, respectively, the interference patterns move at an apparent velocity of (deltaomega/2omega)upsilon(shear), where upsilon(shear) is the shear wave speed. We name the moving interference patterns "crawling waves." In this paper, we extend the techniques to inspect biomaterials with nonuniform stiffness distributions. A relationship between the local crawling wave speed and the local shear wave velocity is derived. In addition, a modified technique is proposed whereby only one shear wave source propagates shear waves into the medium at the frequency omega. The ultrasound probe is externally vibrated at the frequency omega-deltaomega. The resulting field estimated by the ultrasound (US) scanner is proven to be an exact representation of the propagating shear wave field. The authors name the apparent wave motion "holography waves." Real-time video sequences of both types of waves are acquired on various inhomogeneous elastic media. The distribution of the crawling/holographic wave speeds are estimated. The estimated wave speeds correlate with the stiffness distributions.

Statistical strategy for anisotropic adventitia modelling in IVUS

Vessel plaque assessment by analysis of intravascular ultrasound sequences is a useful tool for cardiac disease diagnosis and intervention. Manual detection of luminal (inner) and media-adventitia (external) vessel borders is the main activity of physicians in the process of lumen narrowing (plaque) quantification. Difficult definition of vessel border descriptors, as well as, shades, artifacts, and blurred signal response due to ultrasound physical properties trouble automated adventitia segmentation. In order to efficiently approach such a complex problem, we propose blending advanced anisotropic filtering operators and statistical classification techniques into a vessel border modelling strategy. Our systematic statistical analysis shows that the reported adventitia detection achieves an accuracy in the range of interobserver variability regardless of plaque nature, vessel geometry, and incomplete vessel borders.

Factors influencing the accuracy of biomechanical breast models

Recently it has been suggested that finite element methods could be used to predict breast deformations in a number of applications, including comparison of multimodality images, validation of image registration and image guided interventions. Unfortunately knowledge of the mechanical properties of breast tissues is limited. This study evaluated the accuracy with which biomechanical breast models based on finite element methods can predict the displacements of tissue within the breast in the practical clinical situation where the boundaries of the organ might be known reasonably accurately but there is some uncertainty on the mechanical properties of the tissue. For two datasets, we investigate the influence of tissue elasticity values, Poisson's ratios, boundary conditions, finite element solvers and mesh resolutions. Magnetic resonance images were acquired before and after compressing each volunteer's breast by about 20%. Surface displacement boundary conditions were derived from a three-dimensional nonrigid image registration. Six linear and three nonlinear elastic material models with and without skin were tested. These were compared to hyperelastic models. The accuracy of the models was evaluated by assessing the ability of the model to predict the location of 12 corresponding anatomical landmarks. The accuracy was most sensitive to the Poisson's ratio and the boundary condition. Best results were achieved for accurate boundary conditions, appropriate Poisson's ratios and models where fibroglandular tissue was at most four times stiffer than fatty tissue. These configurations reduced the mean (maximum) distance of the landmarks from 6.6 mm (12.4 mm) to 2.1 mm (3.4 mm) averaged over all experiments.

Multiple-image radiography for human soft tissue

Conventional radiography only provides a measure of the X-ray attenuation caused by an object; thus, it is insensitive to other inherent informative effects, such as refraction. Furthermore, conventional radiographs are degraded by X-ray scatter that can obscure important details of the object being imaged. The novel X-ray technology diffraction-enhanced imaging (DEI) has recently allowed the visualization of nearly scatter-free images displaying both attenuation and refraction properties. A new method termed multiple-image radiography (MIR) is a significant improvement over DEI, corrects errors in DEI, is more robust to noise and produces an additional image that is entirely new to medical imaging. This new image, which portrays ultra-small-angle X-ray scattering (USAXS) conveys the presence of microstructure in the object, thus differentiating homogeneous tissues from tissues that are irregular on a scale of micrometres. The aim of this study was to examine the use of MIR for evaluation of soft tissue, and in particular to conduct a preliminary investigation of the USAXS image, which has not previously been used in tissue imaging.

Application of ultrasound-tagged photons for measurement of amplitude of vibration of tissue caused by ultrasound: theory, simulation, and experiments

We investigate the modulation of an optical field caused by its interaction with an ultrasound beam in a tissue mimicking phantom. This modulation appears as a modulation in the intensity autocorrelation, which is measured by a photon counting correlator. The factors contributing to the modulation are: 1. amplitude of vibration of the particles of the tissue, 2. refractive index modulation, and 3. absorption coefficient in the region of the tissue intercepted by the ultrasound beam and light. We show in this work that a significant part of the contribution to this modulation comes from displacement of the tissue particles, which in turn is governed by the elastic properties of the tissue. We establish, both through simulations and experiments using an optical elastography phantom, the effects of the elasticity and absorption coefficient variations on the modulation of intensity autocorrelation. In the case where there is no absorption coefficient variation, we suggest that the depth of modulation can be calibrated to measure the displacement of tissue particles that, in turn, can be used to measure the tissue elasticity.

Evaluation of nonscanned mode soft-tissue thermal index in the presence of the residual temperature rise

Previously, the temperature rise (deltaT) caused by diagnostic ultrasound and the AUIM/NEMA-defined thermal indices were examined to evaluate whether these indices were reasonable indicators of potential bioeffects due to ultrasound heating in the absence of a residual temperature rise (RTR). In our study, deltaT induced by diagnostic ultrasound exposures was estimated in the presence of an RTR using the Bioheat Transfer Equation. To evaluate deltaT/TIS in the presence of an RTR, 11 frequencies, eight cooling times, eight insonation times for the second ultrasound examination, and three source powers for a circular aperture (A(aprt)< or = 1 cm2) were investigated. In our comparison of the ratios of deltaT/TIS in the absence and presence of an RTR, a higher deltaT/TIS value was obtained in the examination with the RTR. We showed that the deltaT/TIS value is equal to 2.88 in the presence of an RTR, whereas the deltaT/TIS value without the RTR equals 1.90. In the presence of the RTR, although the TIS does not inform the user of higher ultrasound heating due to TIS values that do not exceed 1.00, deltaT reaches 2.62 degrees C, and the deltaT without the RTR reaches 1.68 degrees C in the case of a TIS value that does not exceed 1.00. These results suggest that, for nonscanned mode situations where soft tissue is insonated, the TIS should not be regarded as a reliable indicator of potential bioeffects due to ultrasound heating in the presence of the RTR. Our study also indicates the necessity for a new indicator that provides the clinical user with accurate in vivo temperature rise feedback (possibly even true deltaT), and includes adding an exposure time component to the Bio-Heat Equation model.

Comments on ‘The effect of logarithmic compression on the estimation of the Nakagami parameter for ultrasonic tissue characterization’

In a recently published paper (Tsui et al 2005 Phys. Med. Biol. 50 3235-44), the authors demonstrated estimation of the Nakagami parameter of the logcompressed envelopes and the application of such an approach in ultrasonic tissue characterization. The comments in this letter suggest that the authors ignored some important statistical properties of logcompressed data leading to serious errors in their studies and results.

Sol-gel transition in agar-gelatin mixtures studied with transient elastography

Using the shear wave propagation in solids, the transient elastography technique has been developed to assess the elastic properties of soft tissues. Here, a new approach of transient elastography allows assessing the viscoelastic properties of soft tissues. In this paper, the method is used to follow-up the sol-gel transition of an agar-gelatin mixture noninvasively. The shear wave velocity and shear wave attenuation through the mixture were continuously monitored in the audible range of frequencies (from 50 Hz to 200 Hz). The observed changes in velocities and attenuations as a function of frequency confirmed the validity of the Voigt's model to describe the gel at its stable mechanical state. By a simple inverse problem approach, based on the one-dimensional (1-D) Helmholtz equation, the elasticity and the viscosity of such a mixture were recovered as a function of time. The results obtained are in good agreement with the literature and theoretical predictions. Overall, they demonstrate the high sensitivity of the transient elastography measurements to the rheological parameter changes in agar-gelatin mixtures during gelation.

Morphological changes of collagen fibrils in the subsynovial connective tissue in carpal tunnel syndrome

BACKGROUND

Pathologic changes occur commonly in the subsynovial connective tissue in patients with carpal tunnel syndrome. The purposes of this study were to investigate the ultrastructural changes of the subsynovial connective tissue in these patients and compare them with the findings in cadaver controls.

METHODS

The diameter and density of collagen fibrils were measured by transmission electron microscopy in specimens of subsynovial connective tissue from ten patients with idiopathic carpal tunnel syndrome and from ten fresh-frozen cadavers of individuals without known symptoms of carpal tunnel syndrome.

RESULTS

We noted deformed collagen fibrils with a spiraled appearance in the specimens from the patients. We also observed phagocytosis of elastin fibrils in all of those specimens. These changes were noted only rarely in the cadaver controls. The mean diameter (and standard deviation) of the collagen fibrils was 45.5 +/- 8.0 nm in the control group and 54.8 +/- 15.2 nm in the patient group (p < 0.05). The mean number of collagen fibrils per 0.04 microm2 (density) was 201.38 +/- 48.88 in the control group and 157.08 +/- 54.38 in the patient group (p < 0.05).

CONCLUSIONS

These ultrastructural findings suggest that subsynovial collagen in patients with carpal tunnel syndrome is structurally different from that in individuals without carpal tunnel syndrome, but the processes resulting in that abnormal morphology remain to be elucidated.

Analysis of microstructural alterations of normal and pathological breast tissue in vivo using the AR cepstrum

The mean scatterer spacing is considered to be an important parameter for describing ultrasonic scattering and characterization of biological tissue. Autoregressive models are widely used in parametric techniques for spectral estimation. In this paper, we describe the results of a careful examination of the mean scatterer spacing parameter in normal and pathological breast tissues in vivo using the autoregressive cepstrum. Our experimental results carried out at 4.5 MHz using weakly focused pulse-echo single element transducer show that the mean scatterer spacing in normal breast tissues in vivo is 1.25+/-0.21 mm whereas in several pathological breast tissues, it is between 0.82+/-0.10 and 1.09+/-0.07 mm. These results indicate good correlation with microstructure of breast tissue characterization, and hence the AR cepstrum holds promise that it could be used as an effective method for signal analysis of ultrasonic scattering and characterization of breast tissues scatterers.

Ultrasound detection of soft and bony tissues in congenital hand malformations. Examples taken in daily paediatric surgical clinics

According to the everyday use of ultrasound in the whole field of paediatric surgery we would like to define its potential role in the assessment of congenital hand malformation (CHM). We therefore tested it for several diagnoses like digitus saltans, camptodactylism, triphalangeal thumb and syndrome-associated malformations in comparison as well as in addition to clinical and x-ray findings. All soft and bony tissue details could be displayed reasonable giving the paediatric surgeon additional information. Additional information that is available at the bedside, non-invasive, less costly and does not use ionising radiation.

Enhancing digital cephalic radiography with mixture models and local gamma correction

We present a new algorithm, called the soft-tissue filter, that can make both soft and bone tissue clearly visible in digital cephalic radiographies under a wide range of exposures. It uses a mixture model made up of two Gaussian distributions and one inverted lognormal distribution to analyze the image histogram. The image is clustered in three parts: background, soft tissue, and bone using this model. Improvement in the visibility of both structures is achieved through a local transformation based on gamma correction, stretching, and saturation, which is applied using different parameters for bone and soft-tissue pixels. A processing time of 1 s for 5 Mpixel images allows the filter to operate in real time. Although the default value of the filter parameters is adequate for most images, real-time operation allows adjustment to recover under- and overexposed images or to obtain the best quality subjectively. The filter was extensively clinically tested: quantitative and qualitative results are reported here.

Mechanical properties and functional importance of pulley bands or 'faisseaux tendineux'

INTRODUCTION

Connective tissue bands connect the horizontal rectus muscles at the level of the posterior pole to the orbital wall. These bands, referred to as pulley bands or faisseaux tendineux, purportedly act like springs to keep the rectus muscle bellies in place during eye movement out of the plane of the muscle. We examined the mechanical properties of these bands in human specimens obtained during surgery. In addition, we examined eye motility and stability of rectus muscles in a patient who had no functional pulley bands.

METHODS

Exenterations were carried out on two patients with sebaceous gland carcinoma. Pulley bands were identified and force-elongation behavior was examined with a forceps and a force gauge. Stability of rectus muscles was examined in a patient with severe Crouzon's syndrome by orbital CT scans and during surgery under local, eye drop, anesthesia.

RESULTS

The pulley bands showed leash-like mechanical behavior: they were slack over approximately 10mm and became taut when stretched further. In the patient with Crouzon's syndrome, both CT and observation of the muscle during surgery showed little sideways displacement of the muscle bellies in eye movement out of the plane of the muscle, despite the lack of functional pulley bands.

DISCUSSION

The leash-like mechanical behavior of the pulley bands seems unsuited for stabilization of the muscle bellies. The patient with Crouzon's syndrome had relatively good eye motility and stable rectus muscle paths despite the lack of functional pulley bands.

Acoustic detection of controlled laser-induced microbubble creation in gelatin

A high-frequency (85 MHz) acoustic technique is used to identify system parameters for controlled laser-induced microbubble creation inside tissue-mimicking, gelatin phantoms. Microbubbles are generated at the focus of an ultrafast 793-nm laser source and simultaneously monitored through ultrasonic pulse-echo recordings. Displayed in wavefield form, these recordings illustrate microbubble creation, and integrated backscatter plots provide specifics about microbubble characteristics and dissolution behavior. By varying laser parameters, including pulse fluence (or pulse energy flux, J/cm2), total number of pulses delivered, and the period between pulses, the size, lifetime, and dissolution dynamics of laser-induced microbubbles may be independently controlled. Pulse fluence is the main size-controlling parameter, whereas both increases in pulse fluence and pulse number can lengthen microbubble lifetime from tens to hundreds of milliseconds. In short, a microbubble of particular lifetime does not necessarily have to be of a particular size. Microbubble behavior, furthermore, is independent of pulse periods below a fluence-dependent threshold value, but it exhibits stochastic behavior if pulse repetition is too slow. These results demonstrate that laser pulse fluence, number, and period may be varied to deposit energy in a specific temporal manner, creating and stabilizing microbubbles with particular characteristics and, therefore, potential uses in sensitive acoustic detection and manipulation schemes.

Evaluation of the spectral fit algorithm as functions of frequency range and deltakaeff

Considerable effort has been directed at quantifying the properties of the tissue microstructure (i.e., scatterer correlation length) to diagnose disease and monitor treatment. In vivo assessments have had limited success due to frequency-dependent attenuation along the propagation path (i.e., total attenuation) masking the frequency dependence of the scattering from the tissue microstructure. Previously, both total attenuation and scatterer correlation length, given by the effective radius, were solved simultaneously by a two-parameter minimization of the mean squared error between a reference spectrum, modified by the attenuation and scatterer effective radius, and the backscattered waveforms using an algorithm termed the spectral fit algorithm. Herein, the impact of frequency range (largest frequency minus smallest frequency) and deltakaeff (largest kaeff value minus smallest kaeff value; k is wave number and aeff is scatterer effective radius) used by the spectral fit algorithm on estimating the scatterer effective radius, and total attenuation was assessed by computer simulations while excluding frequencies of the backscattered power spectrum dominated by electronic noise. The simulations varied the effective radius of the scatterers (5 microm to 150 microm), the attenuation of the region (0 to 1 dB/cm-MHz), the bandwidth of the source, and the amount of electronic noise added to the radio frequency (rf) waveforms. The center frequency of the source was maintained at 8 MHz. Comparable accuracy and precision of the scatterer effective radius were obtained for all the simulations whenever the same deltakaeff was used to obtain the estimates. A deltakaeff of 1 gave an accuracy and precision of approximately 15% +/- 35%, and a width of 1.5 gave an accuracy and precision of approximately 5% +/- 15% consistently for all of the simulations. Similarly, the accuracy and precision of the total attenuation estimate were improved by increasing the frequency range used by the spectral fit algorithm.

Effects of aging on the plantar soft tissue properties under the metatarsal heads at different impact velocities

The plantar soft tissue properties under the metatarsal heads at different impact velocities in different age groups were measured. Each metatarsus of the left foot in healthy young adults (n = 9, 19 to 35 years old) and in healthy older persons (n = 10, 42 to 72 years old) was examined in vivo using a self-constructed loading-unloading device at low, medium and high impact status; the impact velocities of the device were about 2.5, 5 and 10 cm/s, respectively. The device comprised a 5- to 12-MHz linear-array ultrasound transducer, a miniature load cell and a fixation frame. From low to high impact status, the elastic modulus (E) in young adults significantly increased from about 300 kPa to about 500 kPa. However, the E in the older group did not show this trend. From low to high impact status, the energy dissipation ratio (EDR) of the metatarsus significantly increased from about 30% to about 60% in the young group and significantly increased from about 40% to about 70% in the older group. Most of the metatarsus in the older subjects had significantly greater E and EDR than those in the younger persons.

The Hot Skull Sign on Bone Scans of Obese Patients Resulting from Disparate Soft Tissue Attenuation

We have frequently observed diffusely increased skull activity on bone scans of obese patients, who do not have evidence of metabolic or metastatic bone disease. Skull activity of 25 obese patients were compared to that of age and sex-matched nonobese 25 patients visually and quantitatively. The results clearly indicated that diffusely increased skull activity is significantly more common on bone scans of obese patients because of disparate attenuation of overlying soft tissues. This knowledge will help obviate the need for additional radiologic and/or laboratory tests in search of other conditions associated with hot skull, ie, Paget's disease and metabolic bone disorders such as renal osteodystrophy and primary hyperparathyroidism.

A finite-element method model of soft tissue response to impulsive acoustic radiation force

Several groups are studying acoustic radiation force and its ability to image the mechanical properties of tissue. Acoustic radiation force impulse (ARFI) imaging is one modality using standard diagnostic ultrasound scanners to generate localized, impulsive, acoustic radiation forces in tissue. The dynamic response of tissue is measured via conventional ultrasonic speckle-tracking methods and provides information about the mechanical properties of tissue. A finite-element method (FEM) model has been developed that simulates the dynamic response of tissues, with and without spherical inclusions, to an impulsive acoustic radiation force excitation from a linear array transducer. These FEM models were validated with calibrated phantoms. Shear wave speed, and therefore elasticity, dictates tissue relaxation following ARFI excitation, but Poisson's ratio and density do not significantly alter tissue relaxation rates. Increased acoustic attenuation in tissue increases the relative amount of tissue displacement in the near field compared with the focal depth, but relaxation rates are not altered. Applications of this model include improving image quality, and distilling material and structural information from tissue's dynamic response to ARFI excitation. Future work on these models includes incorporation of viscous material properties and modeling the ultrasonic tracking of displaced scatterers.

Dual-Energy X-Ray Absorptiometry Analysis of Implants in Rat Tibiae

Dual energy x-ray absorptiometry (DXA) was evaluated for its ability to measure changes in bone mineral density in isolated rat tibiae. This technique is available for in vivo use to potentially augment or replace some aspects of conventional histomorphometric techniques used for the evaluation of metallic implant-to-bone interfaces. Known quantities of hydroxyapatite powder, representing various bone densities, were measured using DXA in a series of 3 experiments: (1) the hydroxyapatite powder was placed within a plastic tube, (2) the hydroxyapatite was placed within an excised rat tibia, and (3) hydroxyapatite powder was placed within a rat tibia with soft tissue overlying it. Statistical analysis (analysis of variance) showed significant differences in bone mineral density among groups that varied by only 5% hydroxyapatite density within the plastic tubes. The system detected hydroxyapatite changes of 20% within the tibiae with and without overlying soft tissue (P < 0.05). These data were consistent and linear (R > 0.90). Although DXA analysis has been widely used in clinical and research applications for detection of osteoporosis, its use for documenting bone growth around implants has not been widely reported. The use of such a technique could have substantial benefits for both the clinical and research arenas. These data show that DXA analysis to identify bone density changes adjacent to implants has significant applications in small animal research models.

Computer simulation of forward wave propagation in soft tissue

A method for simulating forward wavefront propagation in heterogeneous tissue is discussed. The intended application of this method is for the study of aberration produced when performing ultrasound imaging through a layer of soft tissue. A one-way wave equation that permits smooth variation in all acoustically important variables is derived. This equation also describes tissue exhibiting nonlinear elasticity and arbitrary frequency-dependent relaxation. A numerical solution to this equation is found by means of operator splitting and propagation along the spatial depth coordinate. The numerical solution is accurate when compared to analytical solutions for special cases, and when compared to numerical solutions of the full wave equation by other methods. The presented implementation provides a fast numerical method for studying the impact of aberration in medical ultrasound imaging through soft tissue--both on the transmitted beam and the nonlinearly generated harmonic beam.

Model-based ultrasound tomography: Tissue phantom experiments

We present a detailed experimental study to evaluate our finite element based nonlinear reconstruction algorithm for recovery of acoustic properties in heterogeneous scattering media. Using a circularly scanning ultrasound system at 500 KHz, tissue phantom experiments were performed to study spatial resolution and contrast issues in model-based ultrasound tomography. Our results show that both acoustic attenuation and speed images can be quantitatively reconstructed in terms of the location, size, shape, and acoustic property value of the target when different contrast levels between the target and background were used. We also demonstrate that a high contrast target as small as 3 mm in diameter can be quantitatively resolved with our acoustic speed and attenuation images.

Tumoral calcinosis in infants: a report of three cases and review of the literature

Tumoral calcinosis is the deposition of calcium crystals and salts in the periarticular soft tissues. It commonly is seen as a complication of renal dialysis or in patients with a hereditary disposition. Occasionally, it is seen as an isolated condition with no known cause. Tumoral calcinosis usually affects adults and rarely, children. This disorder is extremely uncommon in infants. Only 13 cases have been reported. In this study three additional infants with tumoral calcinosis are reported, bringing the total to 16 cases. These 16 cases provide the opportunity to compare tumoral calcinosis in infants (younger than 18 months) with the disease in older patients. Although histologic and radiologic features in infants and adults are identical, some clinical features differ. In almost all infants, the disease develops without any predisposing factors, such as a family history. Surgical removal of lesions in infants is curative. By contrast, lesions in adults tend to recur after surgery.

A novel noncontact ultrasound indentation system for measurement of tissue material properties using water jet compression

This study is aimed to develop a novel noncontact ultrasonic indentation system for measuring quantitative mechanical properties of soft tissues, which are increasingly important for tissue assessment and characterization. The key idea of this method is to use a water jet as an indenter to compress the soft tissue while at the same time as a medium for an ultrasound beam to propagate through. The use of water jet indentation does not require a rigid compressor in front of the focused high frequency ultrasound transducer to compress the tissue, so that the additional attenuation caused by the rigid compressor and the strong echoes reflected from its surfaces can be avoided. The indentation deformation was estimated from the ultrasound echoes using a cross-correlation algorithm and the indentation force was calculated from the water pressure measured inside the water pipe. Experiments were performed on uniform tissue-mimicking phantoms with different stiffness. The Young's moduli and Poisson's ratios of these phantoms were measured using a uniaxial ultrasound compression system. The ratio of the indentation pressure to the tissue relative deformation was obtained from the water indentation. This ratio was well correlated with the Young's modulus (r = 0.87). The results also demonstrated that the water indentation approach could differentiate materials with different stiffness in a combined phantom (288 kPa and 433 kPa). This novel noncontact water indentation approach could be potentially used for the measurement of the elasticity of small samples and with a fast scanning speed.

Electrical impedance along connective tissue planes associated with acupuncture meridians

Background

Acupuncture points and meridians are commonly believed to possess unique electrical properties. The experimental support for this claim is limited given the technical and methodological shortcomings of prior studies. Recent studies indicate a correspondence between acupuncture meridians and connective tissue planes. We hypothesized that segments of acupuncture meridians that are associated with loose connective tissue planes (between muscles or between muscle and bone) visible by ultrasound have greater electrical conductance (less electrical impedance) than non-meridian, parallel control segments.

Methods

We used a four-electrode method to measure the electrical impedance along segments of the Pericardium and Spleen meridians and corresponding parallel control segments in 23 human subjects. Meridian segments were determined by palpation and proportional measurements. Connective tissue planes underlying those segments were imaged with an ultrasound scanner. Along each meridian segment, four gold-plated needles were inserted along a straight line and used as electrodes. A parallel series of four control needles were placed 0.8 cm medial to the meridian needles. For each set of four needles, a 3.3 kHz alternating (AC) constant amplitude current was introduced at three different amplitudes (20, 40, and 80 μAmps) to the outer two needles, while the voltage was measured between the inner two needles. Tissue impedance between the two inner needles was calculated based on Ohm's law (ratio of voltage to current intensity).

Results

At the Pericardium location, mean tissue impedance was significantly lower at meridian segments (70.4 ± 5.7 Ω) compared with control segments (75.0 ± 5.9 Ω) (p = 0.0003). At the Spleen location, mean impedance for meridian (67.8 ± 6.8 Ω) and control segments (68.5 ± 7.5 Ω) were not significantly different (p = 0.70).

Conclusion

Tissue impedance was on average lower along the Pericardium meridian, but not along the Spleen meridian, compared with their respective controls. Ultrasound imaging of meridian and control segments suggested that contact of the needle with connective tissue may explain the decrease in electrical impedance noted at the Pericardium meridian. Further studies are needed to determine whether tissue impedance is lower in (1) connective tissue in general compared with muscle and (2) meridian-associated vs. non meridian-associated connective tissue.

Classification, reproducibility and prevalence of root proximity in periodontal patients

AIM

The primary aim of this study is to define and classify root proximity. The secondary aim is to examine the reproducibility of the measurement tools, to study the prevalence per inter-dental area and to examine whether the distance from the cemento-enamel junction (CEJ) to the bone crest (BC) differs between sites with root proximity and their contra-lateral sites without root proximity.

MATERIAL AND METHODS

In order to indicate the location of root proximity, a modification of the Shei ruler was developed, dividing the roots into three equal parts. A radiographic template was used to measure the distance between the roots, in this way determining the severity of the root proximity. The reproducibility of the measurement tool was tested, the prevalence was calculated and the distances CEJ-BC for root proximity sites and contra-lateral sites were recorded.

RESULTS

A two-digit classification was obtained dividing the root into three locations [apical (A), between (B) and coronal (C)], with each location having the possibility of three different severities of root proximity. The described modification of the Shei ruler and the measurement tool for the severities can be considered as reproducible measurement tools. Root proximity was most prevalent in maxillary molars and between central and lateral incisors in the maxilla and mandible. There was no difference in CEJ-BC distance between the root proximity sites and their contra-lateral sites.

CONCLUSION

We can conclude that a two-digit classification for root proximity was established. Root proximity in untreated periodontal patients has no influence on the distance CEJ-BC. However, the location of root proximity becomes important from the moment that periodontal disease has been established at that site. The severity of root proximity is important for choosing treatment options. There is a striking similarity between bone loss patterns and tooth loss and the location of inter-dental spaces where root proximity is most prevalent.

The influence of antiscatter grids on soft-tissue detectability in cone-beam computed tomography with flat-panel detectors

The influence of antiscatter x-ray grids on image quality in cone-beam computed tomography (CT) is evaluated through broad experimental investigation for various anatomical sites (head and body), scatter conditions (scatter-to-primary ratio (SPR) ranging from approximately 10% to 150%), patient dose, and spatial resolution in three-dimensional reconstructions. Studies involved linear grids in combination with a flat-panel imager on a system for kilovoltage cone-beam CT imaging and guidance of radiation therapy. Grids were found to be effective in reducing x-ray scatter "cupping" artifacts, with heavier grids providing increased image uniformity. The system was highly robust against ring artifacts that might arise in CT reconstructions as a result of gridline shadows in the projection data. The influence of grids on soft-tissue detectability was evaluated quantitatively in terms of absolute contrast, voxel noise, and contrast-to-noise ratio (CNR) in cone-beam CT reconstructions of 16 cm "head" and 32 cm "body" cylindrical phantoms. Imaging performance was investigated qualitatively in observer preference tests based on patient images (pelvis, abdomen, and head-and-neck sites) acquired with and without antiscatter grids. The results suggest that although grids reduce scatter artifacts and improve subject contrast, there is little strong motivation for the use of grids in cone-beam CT in terms of CNR and overall image quality under most circumstances. The results highlight the tradeoffs in contrast and noise imparted by grids, showing improved image quality with grids only under specific conditions of high x-ray scatter (SPR> 100%), high imaging dose (Dcenter> 2 cGy), and low spatial resolution (voxel size > or = 1 mm).

Potential use of high-resolution two-dimensional transthoracic echocardiography for visualization of the left anterior descending coronary artery

High-resolution, two-dimensional transthoracic echocardiography (HR-2DTTE) can detect the difference in the left anterior descending coronary artery (LAD) wall thickness between patients with coronary artery disease and patients with normal coronary arteries. However, HR-2DTTE measurements of the LAD wall thickness are larger than measurements obtained by intravascular ultrasound and histology. This difference may be due to the inclusion of adventitia by HR-2DTTE. We evaluated the contribution of adventitia to the wall thickness of the normal and atherosclerotic LAD by comparing HR-2DTTE with high-frequency epicardial echocardiography. The LAD wall thickness was significantly greater in patients with coronary artery disease by both HR-2DTTE and high-frequency epicardial echocardiography. Both an increase in the intima plus media thickness and an increase in the thickness of adventitia contributed to the increase in the LAD wall thickness in patients with coronary artery disease. Adventitia represents a significant portion of the LAD wall thickness imaged by HR-2DTTE and its thickness increases significantly with the development of atherosclerosis.

The effect on IMRT conformality of elastic tissue movement and a practical suggestion for movement compensation via the modified dynamic multileaf collimator (dMLC) technique

A major remaining problem in delivering radiotherapy, specifically intensity-modulated radiation therapy (IMRT), is the need to accommodate and correct for intrafraction movement. The developing availability of 4D computed tomographic images can potentially form the basis of the new field of image-guided IMRT. It is important to understand the effects on delivered dose of the patient breathing during IMRT and this paper models the effect which applies whether there is or is not a time component to the IMRT delivery method. It then goes on to suggest a practical correction strategy. The 'stretch-and-shift-the-planned-modulations' strategy is proposed and a practical method to deliver this is explained. This practical strategy is based on a modification of the dynamic multileaf collimator IMRT method whereby the leaves are arranged to 'breath' in tandem with the breathing of the patient. Some examples are also given from a study of mismatching the patient and leaf-correction motions.

Ganglion of the groin in a child: an unusual cause of soft-tissue swelling of the groin

A case of groin ganglion with asymptomatic compression of the femoral vein is described. A 2-year-old girl was referred because of a symptomless groin mass. A mass was palpable in the right femoral triangle. Computed tomography and ultrasonography revealed a cystic lesion compressing the femoral vein ventrally. Prompt surgical removal of the cystic lesion was done without complications. Histopathological examination showed a benign structure similar to that of a ganglion.

Soft tissue differentiation using multiband signatures of high resolution ultrasonic transmission tomography

In this paper, we are interested in soft tissue differentiation by multiband images obtained from the High-Resolution Ultrasonic Transmission Tomography (HUTT) system using a spectral target detection method based on constrained energy minimization (CEM). We have developed a new tissue differentiation method (called "CEM filter bank") consisting of multiple CEM filters specially designed for detecting multiple types of tissues. Statistical inference on the output of the CEM filter bank is used to make a decision based on the maximum statistical significance rather than the magnitude of each CEM filter output. We test and validate this method through three-dimensional interphantom/intraphantom soft tissue classification where target profiles obtained from an arbitrary single slice are used for differentiation over multiple other tomographic slices. The performance of the proposed classifier is assessed using receiver operating characteristic analysis. We also apply our method to classify tiny structures inside a bovine kidney and sheep kidneys. Using the proposed method we can detect physical objects and biological tissues such as styrofoam balls, chicken tissue, calyces, and vessel-duct successfully.

Quantification of soft tissue artefact in motion analysis by combining 3D fluoroscopy and stereophotogrammetry: a study on two subjects

BACKGROUND

Soft tissue artefact is the most invalidating source of error in human motion analysis using optoelectronic stereophotogrammetry. It is caused by the erroneous assumption that markers attached to the skin surface are rigidly connected to the underlying bones. The quantification of this artefact in three dimensions and the knowledge of how it propagates to relevant joint angles is necessary for the interpretation of gait analysis data.

METHODS

Two subjects, treated by total knee replacement, underwent data acquisition simultaneously with fluoroscopy and stereophotogrammetry during stair climbing, step up/down, sit-to-stand/stand-to-sit, and extension against gravity. The reference 3D kinematics of the femur and tibia was reconstructed from fluoroscopy-based tracking of the relevant prosthesis components. Soft tissue artefact was quantified as the motion of a grid of retro-reflecting makers attached to the thigh and shank with respect to the underlying bones, tracked by optoelectronic stereophotogrammetry. The propagation of soft tissue artefact to knee rotations was also calculated.

FINDINGS

The standard deviation of skin marker trajectory in the corresponding prosthesis-embedded anatomical frame was found up to 31 mm for the thigh and up to 21 mm for the shank. The ab/adduction and internal/external rotation angles were the most affected by soft tissue artefact propagation, with root mean square errors up to 192% and 117% of the corresponding range, respectively.

INTERPRETATIONS

In both the analysed subjects the proximal thigh showed the largest soft tissue artefact. This is subject- and task-specific. However, larger artefact does not necessarily produce larger propagated error on knee rotations. Propagated errors were extremely critical on ab/adduction and internal/external rotation. These large errors can nullify the usefulness of these variables in the clinical interpretation of gait analysis.

X-ray phase-attenuation duality and phase retrieval

Phase retrieval is the key to quantitative x-ray phase-contrast imaging. To retrieve the phase image of an x-ray wave field, in general one needs multiple phase-contrast images. We have made a new observation of phase-attenuation duality for soft tissues, and we show how only a single phase-contrast image is needed for successful phase retrieval based on this duality. The phase-retrieval formula based on a single phase-contrast image of inhomogeneous soft tissue is derived and presented. We show the striking enhancement of the tissue contrast in simulated phase images that this new approach produces.