H-scan trajectories indicate the progression of specific diseases

Multiparametric ultrasound imaging for early-stage steatosis: Comparison with magnetic resonance imaging-based proton density fat fraction

BACKGROUND

The prevalence of liver diseases, especially steatosis, requires a more convenient and noninvasive tool for liver diagnosis, which can be a surrogate for the gold standard biopsy. Magnetic resonance (MR) measurement offers potential, however ultrasound (US) has better accessibility than MR.

PURPOSE

This study aims to suggest a multiparametric US approach which demonstrates better quantification and imaging performance than MR imaging-based proton density fat fraction (MRI-PDFF) for hepatic steatosis assessment.

METHODS

We investigated early-stage steatosis to evaluate our approach. An in vivo (within the living) animal study was performed. Fat inclusions were accumulated in the animal livers by feeding a methionine and choline deficient (MCD) diet for 2 weeks. The animals (n = 19) underwent US and MR imaging, and then their livers were excised for histological staining. From the US, MR, and histology images, fat accumulation levels were measured and compared: multiple US parameters; MRI-PDFF; histology fat percentages. Seven individual US parameters were extracted using B-mode measurement, Burr distribution estimation, attenuation estimation, H-scan analysis, and shear wave elastography. Feature selection was performed, and the selected US features were combined, providing quantification of fat accumulation. The combined parameter was used for visualizing the localized probability of fat accumulation level in the liver; This procedure is known as disease-specific imaging (DSI).

RESULTS

The combined US parameter can sensitively assess fat accumulation levels, which is highly correlated with histology fat percentage (R = 0.93, p-value < 0.05) and outperforms the correlation between MRI-PDFF and histology (R = 0.89, p-value < 0.05). Although the seven individual US parameters showed lower correlation with histology compared to MRI-PDFF, the multiparametric analysis enabled US to outperform MR. Furthermore, this approach allowed DSI to detect and display gradual increases in fat accumulation. From the imaging output, we measured the color-highlighted area representing fatty tissues, and the fat fraction obtained from DSI and histology showed strong agreement (R = 0.93, p-value < 0.05).

CONCLUSIONS

We demonstrated that fat quantification utilizing a combination of multiple US parameters achieved higher performance than MRI-PDFF; therefore, our multiparametric analysis successfully combined selected features for hepatic steatosis characterization. We anticipate clinical use of our proposed multiparametric US analysis, which could be beneficial in assessing steatosis in humans.

H-Scan Discrimination for Tumor Microenvironmental Heterogeneity in Melanoma

OBJECTIVE

Melanoma is a form of malignant skin cancer that exhibits significant inter-tumoral differences in the tumor microenvironment (TME) secondary to genetic mutations. The heterogeneity may be subtle but can complicate the treatment of metastatic melanoma, contributing to a high mortality rate. Therefore, developing an accurate and non-invasive procedure to discriminate microenvironmental heterogeneity to facilitate therapy selection is an important goal.

METHODS

In vivo murine melanoma models that recapitulate human disease using synchronous implanted YUMM 1.7 (Yale University Mouse Melanoma) and YUMMER 1.7 (Yale University Mouse Melanoma Exposed to Radiation) murine melanoma lines were investigated. Mice were treated with antibodies to modulate the immune response and longitudinally scanned with ultrasound (US). US radiofrequency data were processed using the H-scan analysis, attenuation estimation and B-mode processing to extract five US features. The measures were used to compare different TMEs (YUMMER vs. YUMM) and responses to immunomodulatory therapies with CD8 depletion or programmed cell death protein 1 (PD-1) inhibition.

RESULTS

Multiparametric analysis produced a combined H-scan parameter, resolving significant differences (i) between untreated YUMMER and YUMM and (ii) between untreated, PD-1-treated and CD8-treated YUMMER. However, more importantly, the B-mode and attenuation measures failed to differentiate YUMMER and YUMM and to monitor treatment responses, indicating that H-scan is required to differentiate subtle differences within the TME.

CONCLUSION

We anticipate that the H-scan analysis could discriminate heterogeneous melanoma metastases and guide diagnosis and treatment selection, potentially reducing the need for invasive biopsies or immunologic procedures.

Hermite-scan imaging for differentiating glioblastoma from normal brain: Simulations and ex vivo studies for applications in intra-operative tumor identificationa)

Hermite-scan (H-scan) imaging is a tissue characterization technique based on the analysis of raw ultrasound radio frequency (RF) echoes. It matches the RF echoes to Gaussian-weighted Hermite polynomials of various orders to extract information related to scatterer diameter. It provides a color map of large and small scatterers in the red and blue H-scan image channels, respectively. H-scan has been previously reported for characterizing breast, pancreatic, and thyroid tumors. The present work evaluated H-scan imaging to differentiate glioblastoma tumors from normal brain tissue ex vivo. First, we conducted 2-D numerical simulations using the k-wave toolbox to assess the performance of parameters derived from H-scan images of acoustic scatterers (15-150 μm diameters) and concentrations (0.2%-1% w/v). We found that the parameter intensity-weighted percentage of red (IWPR) was sensitive to changes in scatterer diameters independent of concentration. Next, we assessed the feasibility of using the IWPR parameter for differentiating glioblastoma and normal brain tissues (n = 11 samples per group). The IWPR parameter estimates for normal tissue (44.1% ± 1.4%) were significantly different (p < 0.0001) from those for glioblastoma (36.2% ± 0.65%). These findings advance the development of H-scan imaging for potential use in differentiating glioblastoma tumors from normal brain tissue during resection surgery.

Improving breast cancer diagnosis by incorporating raw ultrasound parameters into machine learning

The improved diagnostic accuracy of ultrasound breast examinations remains an important goal. In this study, we propose a biophysical feature-based machine learning method for breast cancer detection to improve the performance beyond a benchmark deep learning algorithm and to furthermore provide a color overlay visual map of the probability of malignancy within a lesion. This overall framework is termed disease-specific imaging. Previously, 150 breast lesions were segmented and classified utilizing a modified fully convolutional network and a modified GoogLeNet, respectively. In this study multiparametric analysis was performed within the contoured lesions. Features were extracted from ultrasound radiofrequency, envelope, and log-compressed data based on biophysical and morphological models. The support vector machine with a Gaussian kernel constructed a nonlinear hyperplane, and we calculated the distance between the hyperplane and each feature's data point in multiparametric space. The distance can quantitatively assess a lesion and suggest the probability of malignancy that is color-coded and overlaid onto B-mode images. Training and evaluation were performed on in vivo patient data. The overall accuracy for the most common types and sizes of breast lesions in our study exceeded 98.0% for classification and 0.98 for an area under the receiver operating characteristic curve, which is more precise than the performance of radiologists and a deep learning system. Further, the correlation between the probability and Breast Imaging Reporting and Data System enables a quantitative guideline to predict breast cancer. Therefore, we anticipate that the proposed framework can help radiologists achieve more accurate and convenient breast cancer classification and detection.

Power laws prevail in medical ultrasound

Major topics in medical ultrasound rest on the physics of wave propagation through tissue. These include fundamental treatments of backscatter, speed of sound, attenuation, and speckle formation. Each topic has developed its own rich history, lexicography, and particular treatments. However, there is ample evidence to suggest that power law relations are operating at a fundamental level in all the basic phenomena related to medical ultrasound. This review paper develops, from literature over the past 60 years, the accumulating theoretical basis and experimental evidence that point to power law behaviors underlying the most important tissue-wave interactions in ultrasound and in shear waves which are now employed in elastography. The common framework of power laws can be useful as a coherent overview of topics, and as a means for improved tissue characterization.

Disease-Specific Imaging Utilizing Support Vector Machine Classification of H-Scan Parameters: Assessment of Steatosis in a Rat Model

In medical imaging, quantitative measurements have shown promise in identifying diseases by classifying normal versus pathological parameters from tissues. The support vector machine (SVM) has shown promise as a supervised classification algorithm and has been widely used. However, the classification results typically identify a category of abnormal tissues but do not necessarily differentiate progressive stages of a disease. Moreover, the classification result is typically provided independently as a supplement to medical images, which contributes to an overload of information sources in the clinic. Hence, we propose a new imaging method utilizing the SVM to integrate classification results into medical images. This framework is called disease-specific imaging (DSI) that produces a color overlaid highlight on B-mode ultrasound images indicating the type, location, and severity of pathology from different conditions. In this article, the SVM training was performed to construct hyperplanes that can differentiate normal, fibrosis, steatosis, and pancreatic ductal adenocarcinoma (PDAC) metastases in livers based on ultrasound echoes. Also, cluster centroids for specific diseases define unique disease axes, and the inner product between measured features and any disease axis selected by the SVM quantifies the disease progression. The features were measured from 2794 ultrasound frames using the H-scan analysis, attenuation estimation, and B-mode image analysis. The performance of our proposed DSI method was evaluated for a preclinical model of steatosis ( n = 400 frames). The contribution of each feature was assessed, and the results were compared with ground truth from histology. Moreover, the images generated by our DSI were compared with earlier imaging methods of B-mode, H-scan, and histology. The comparisons demonstrate that DSI images yield higher sensitivity to monitor progressive steatosis than B-mode and H-scan and provide a comparable performance with the histology. For the parameter comparison, DSI and H-scan resulted in similar correlation with histology ( r_s = 0.83 ) but higher than attenuation ( r_s = 0.73 ) and B-mode ( r_s = 0.47 ). Therefore, we conclude that DSI utilizing the SVM applied to steatosis can visually represent the classification results with color highlighting, which can simplify the interpretation of classification compared to the traditional SVM result. We expect that the proposed DSI can be used for any medical imaging modality that can estimate multiple quantitative parameters at high resolution.