In vitro evaluation of ultrasound Doppler strain rate imaging: modification for measurement in a slowly moving tissue phantom

Ultrasonography in gastroenterology

Ultrasonography (US) is a safe and available real-time, high-resolution imaging method, which during the last decades has been increasingly integrated as a clinical tool in gastroenterology. New US applications have emerged with enforced data software and new technical solutions, including strain evaluation, three-dimensional imaging and use of ultrasound contrast agents. Specific gastroenterologic applications have been developed by combining US with other diagnostic or therapeutic methods, such as endoscopy, manometry, puncture needles, diathermy and stents. US provides detailed structural information about visceral organs without hazard to the patients and can play an important clinical role by reducing the need for invasive procedures. This paper presents different aspects of US in gastroenterology, with a special emphasis on the contribution from Nordic scientists in developing clinical applications.

Elastography and strain rate imaging of the gastrointestinal tract

Ultrasound based elastography of the gastrointestinal tract may be a useful approach to improved tissue characterisation. Distinguishing malignant lesions from benign may be one useful application. Monitoring of inflammatory bowel lesions for degree of inflammation or fibrosis would be another clinically useful tool. The anatomy of the bowel, however, raises many challenges for strain or shear wave imaging due to thin structures, non-constant boundary conditions and intrinsic contractility. Pathological lesions tend to increase bowel wall thickness and may ease elastography imaging. Very few studies have addressed issues of bowel wall elastography so far, and both inflammatory and neoplastic lesions seem to increase tissue hardness in the bowel wall.

Evaluation of ultrasound Tissue Velocity Imaging: a phantom study of velocity estimation in skeletal muscle low-level contractions

Background

Tissue Velocity Imaging (TVI) is an ultrasound based technique used for quantitative analysis of the cardiac function and has earlier been evaluated according to myocardial velocities. Recent years several studies have reported applying TVI in the analysis of skeletal muscles. Skeletal tissue velocities can be very low. In particular, when performing isometric contractions or contractions of low force level the velocities may be much lower compared to the myocardial tissue velocities.

Methods

In this study TVI was evaluated for estimation of tissue velocities below the typical myocardial velocities. An in-house phantom was used to see how different PRF-settings affected the accuracy of the velocity estimations.

Results

With phantom peak velocity at 0.03 cm/s the error ranged from 31% up to 313% with the different PRF-settings in this study. For the peak velocities at 0.17 cm/s and 0.26 cm/s there was no difference in error with tested PFR settings, it is kept approximately around 20%.

Conclusions

The results from the present study showed that the PRF setting did not seem to affect the accuracy of the velocity estimation at tissue velocities above 0.17 cm/s. However at lower velocities (0.03 cm/s) the setting was crucial for the accuracy. The PRF should therefore preferable be reduced when the method is applied in low-level muscle contraction.

Accuracy of real-time single- and multi-beat 3-d speckle tracking echocardiography in vitro

With little data published on the accuracy of cardiac 3-D strain measurements, we investigated the agreement between 3-D echocardiography and sonomicrometry in an in vitro model with a polyvinyl alcohol phantom. A cardiac scanner with a 3-D probe was used to acquire recordings at 15 different stroke volumes at a heart rate of 60 beats/min, and eight different stroke volumes at a heart rate of 120 beats/min. Sonomicrometry was used as a reference, monitoring longitudinal, circumferential and radial lengths. Both single- and multi-beat acquisitions were recorded. Strain values were compared with sonomicrometer strain using linear correlation coefficients and Bland-Altman analysis. Multi-beat acquisition showed good agreement, whereas real-time images showed less agreement. The best correlation was obtained for a heart rate 60 of beats/min at a volume rate 36.6 volumes/s.

Comparison of 2-D speckle tracking and tissue Doppler imaging in an isolated rabbit heart model

Ultrasound strain imaging has been proposed to quantitatively assess myocardial contractility. Cross-correlation-based 2-D speckle tracking (ST) and auto-correlation-based tissue Doppler imaging (TDI) [often called Doppler tissue imaging (DTI)] are competitive ultrasound techniques for this application. Compared with 2-D ST, TDI, as a 1-D method, is sensitive to beam angle and suffers from low strain signal-to-noise ratio because a high pulse repetition frequency is required to avoid aliasing in velocity estimation. In addition, ST and TDI are fundamentally different in the way that physical parameters such as the mechanical strain are derived, resulting in different estimation accuracy and interpretation. In this study, we directly compared the accuracy of TDI and 2-D ST estimates of instantaneous axial normal strain and accumulated axial normal strain using a simulated heart. We then used an isolated rabbit heart model of acute ischemia produced by left descending anterior artery ligation to evaluate the performance of the two methods in detecting abnormal motion. Results showed that instantaneous axial normal strains derived using TDI (0.36% error) were less accurate with larger variance than those derived from 2-D ST (0.08% error) given the same spatial resolution. In addition to poorer accuracy, accumulated axial normal strain estimates derived using TDI suffered from bias, because the accumulation method for TDI cannot trace along the actual tissue displacement path. Finally, we demonstrated the advantage 2-D ST has over TDI to reduce dependency on beam angle for lesion detection by estimating strains based on the principal stretches and their corresponding principal axes.

Two-dimensional strain imaging of controlled rabbit hearts

Ultrasound strain imaging using 2-D speckle tracking has been proposed to quantitatively assess changes in myocardial contractility caused by ischemia. Its performance must be demonstrated in a controlled model system as a step toward routine clinical application. In this study, a well-controlled 2-D cardiac elasticity imaging technique was developed using two coplanar and orthogonal linear probes simultaneously imaging an isolated retroperfused rabbit heart. Acute ischemia was generated by left anterior descending (LAD) artery ligation. An excitation-contraction decoupler, 2,3-butanedione monoxime, was applied at a 4-mM concentration to reversibly reduce myocardial contractility. Results using a single probe demonstrate that directional changes in the in-plane principal deformation axes can help locate the bulging area as a result of LAD ligation, which matched well with corresponding Evans Blue staining, and strains or strain magnitude, based on principal stretches, can characterize heart muscle contractility. These two findings using asymmetric displacement accuracy (i.e., normal single-probe measurements with good axial but poor lateral estimates) were further validated using symmetric displacement accuracy (i.e., dual-probe measurements using only accurate axial tracking estimates from each). However, the accuracy of 2-D cardiac strain imaging using a single probe depends on the probe's orientation because of the large variance in lateral displacement estimates.

Phase rotation methods in filtering correlation coefficients for ultrasound speckle tracking

In speckle-tracking-based myocardial strain imaging, large interframe/volume peak-systolic strains cause peak hopping artifacts separating the highest correlation coefficient peak from the true peak. A correlation coefficient filter was previously designed to minimize peak hopping artifacts. For large strains, however, the correlation coefficient filter must follow the strain distribution to remove peak hopping effectively. This processing usually means interpolation and high computational load. To reduce the computational burden, a narrow band approximation using phase rotation is developed in this paper to facilitate correlation coefficient filtering. Correlation coefficients are first phase rotated to increase coherence, then filtered. Rotated phase angles are determined by the local strain and spatial position. This form of correlation coefficient filtering enhances true correlation coefficient peaks in large strain applications if decorrelation due to deformation does not completely destroy the coherence among neighboring correlation coefficients. The assumed strain used in the filter can also deviate from the true strain and still be effective. Further improvement in displacement estimation can be expected by combining correlation coefficient filtering with a new Viterbi-based displacement estimator.

Reduced peak-hopping artifacts in ultrasonic strain estimation using the Viterbi algorithm

Internal strain resulting from tissue deformation can be estimated by correlation processing of speckle patterns within complex (i.e., radio frequency) ultrasound images acquired during deformation. At large deformations, the magnitude of the correlation coefficient peak can be significantly lower than unity, so that random speckle correlations will exceed the true peak. This effect is called "peak hopping" and causes significant errors in displacement and deformation estimates. Here we investigate the Viterbi algorithm, a dynamic programming procedure, to overcome peak-hopping artifacts by finding the most likely sequence of hidden states in a sequence of observed events. It is well suited to motion estimation in elasticity-imaging studies because adjacent tissue elements remain adjacent following deformation. Particularly, tissue elements along an ultrasonic beam in one image lie along a 3-D continuous curve in the next image instant. The observed event in this case is the correlation coefficient of a pixel at a certain displacement. Radio-frequency data were generated before and after deformation with an average strain of 6%. Simulations were performed for a homogenous medium and for a medium with a stiffer inclusion. Results show that Viterbi processing of speckle-tracking outputs can significantly reduce peak-hopping artifacts.

Full experimental modelling of a liver tissue mimicking phantom for medical ultrasound studies employing different hydrogels

Tissue mimicking phantoms have been widely reported to be an important tool for development, optimisation and performance testing of ultrasound-based diagnostic techniques. In particular, modern applications of tissue mimicking phantoms often include characterisation of the nonlinear behaviour of experimental ultrasound contrast agents. In such cases, the tissue-mimicking materials should be chosen not only based on the values of their density, speed of sound and attenuation coefficient, but also considering their effect on the appearance of "native harmonics" due to nonlinear distortion of ultrasound signal during propagation. In a previous paper it was demonstrated that a cellulose-based hydrogel is suitable to simulate nonlinear acoustical behaviour of liver tissue for thicknesses up to 8 cm. In this paper we present the experimental characterisation of the nonlinear acoustical behaviour of a different polyethylene glycol diacrylate (PEGDA)-based hydrogel, in order to assess whether and how it can improve the performances and overcome some limitations of the cellulose-based hydrogel as liver tissue-mimicking material. Samples of pig liver tissue, cellulose-based hydrogel and PEGDA-based hydrogel were insonified in a through-transmission set-up, employing 2.25-MHz pulses with different mechanical index (MI) values. Second harmonic and first harmonic amplitudes were extracted from the spectra of received signals and their difference was then used to compare sample behaviours. Obtained results show how a new more accurate and combined experimental model of linear and nonlinear acoustical behaviour of liver tissue is feasible. In fact, a further confirmation of the cellulose-based hydrogel effectiveness to precisely simulate the liver tissue for penetration depths up to 8 cm was provided, and it was also shown that the employment of the PEGDA-based hydrogel can extend the range of useful tissue-mimicking material thicknesses up to 11 cm, moreover allowing a considerable improvement of the time stability and behaviour reliability of the corresponding manufactured phantoms.

Strain measurement during antral contractions by ultrasound strain rate imaging: influence of erythromycin

Strain rate imaging (SRI) is a non-invasive ultrasound (US) modality that enables the study of mechanical deformation (strain) with high spatial and temporal resolution. A total of 244 contractions in seven healthy volunteers were studied by SRI on two separate days to characterize radial strain of antral contractions in the fasting and fed states and to assess the influence of intravenous erythromycin. Gastric accommodation and emptying were assessed by 2D ultrasonography. The perception of hunger was registered by the participants. The strain increased from early to late phase II and phase III activity by (median) 18%, 58% and 82%, respectively, P < 0.05. Erythromycin infusion in phase I induced contractions with median strain of 35%, but did not increase postprandial strain. Both fasting and postprandially, lumen-occlusive contractions with erythromycin were more frequent than in naturally occurring contractions, 69%vs 48%, P = 0.036 and 40%vs 5%, P < 0.001 respectively. All subjects had rumbling in their abdomens when intraluminal air was detected sonographically (85% of all phase III contractions) and that rumbling was perceived by the participant as maximal awareness of hunger. SRI enabled detailed strain measurement of individual antral contractions. Erythromycin initiated fasting antral contractions and increased the number of lumen-occlusive contractions.

Acoustical properties of selected tissue phantom materials for ultrasound imaging

This note summarizes the characterization of the acoustic properties of four materials intended for the development of tissue, and especially breast tissue, phantoms for the use in photoacoustic and ultrasound imaging. The materials are agar, silicone, polyvinyl alcohol gel (PVA) and polyacrylamide gel (PAA). The acoustical properties, i.e., the speed of sound, impedance and acoustic attenuation, are determined by transmission measurements of sound waves at room temperature under controlled conditions. Although the materials are tested for application such as photoacoustic phantoms, we focus here on the acoustic properties, while the optical properties will be discussed elsewhere. To obtain the acoustic attenuation in a frequency range from 4 MHz to 14 MHz, two ultrasound sources of 5 MHz and 10 MHz core frequencies are used. For preparation, each sample is cast into blocks of three different thicknesses. Agar, PVA and PAA show similar acoustic properties as water. Within silicone polymer, a significantly lower speed of sound and higher acoustical attenuation than in water and human tissue were found. All materials can be cast into arbitrary shapes and are suitable for tissue-mimicking phantoms. Due to its lower speed of sound, silicone is generally less suitable than the other presented materials.

Gastric accommodation assessed by ultrasonography

Gastric accommodation is important for the under-standing of the pathophysiology in functional dyspepsia and is also relevant for symptom generation in other disorders. The term gastric accommodation has at least three different meanings: The accommodation process, the accommodation reflex, and the accommodation response. The gastric accommodation process is a complex phenomenon that describes how the size of the gastric compartment changes in response to a meal. The electronic barostat is considered the gold standard in assessing gastric accommodation. Imaging methods, including MRI, SPECT, and ultrasonography may also be used, particularly in patients who are stress-responsive, e.g. functional dyspepsia patients, as a non-invasive and less stress-inducing method is favourable. Ultrasonography satisfies these criteria as it does not by itself distort the physiological response in stress-responsive individuals.

In vitro strain measurement in the porcine antrum using ultrasound doppler strain rate imaging

Strain rate imaging (SRI) enables study of deformation in soft tissues. The aim of this study was to evaluate the accuracy of SRI in measuring strain in the porcine antral wall in vitro. An experimental set-up enabled controlled distension of a porcine stomach in a saline reservoir. Radial strain obtained by SRI was compared with radial strain calculated from B-mode ultrasonography. Circumferential strain obtained by SRI was compared with circumferential strain calculated from sonomicrometry. The agreement between radial strain values measured by SRI and B-mode, along and across several ultrasound (US) beams, using US frequency 6.7 MHz and strain length (SL) = 1.9 mm was = -1.0 +/- 12.1% and 0.5 +/- 13.4%, respectively (mean difference +/- 2SD%) and it was better than with SL 1.2 mm. Compared with sonomicrometry, SRI-determined circumferential strain using 6.7 MHz and SL = 1.9 mm was less accurate, whether averaging along or across several US beams (-9.2 +/- 46.7% and 13.8 +/- 51.2%, respectively). In conclusion, SRI gave accurate measurement of radial strain of the antral wall, but seemed to be less accurate for measurement of circumferential strain for this in vitro set-up.

Radial Strain Gradient Across the Normal Myocardial Wall in Open-chest Pigs Measured with Doppler Strain Rate Imaging

BACKGROUND

One of the reasons for the large variation in radial strain measured with Doppler strain rate imaging in normal myocardium might be the different strain length (SL) used during analyses. The aim of this study was to evaluate the effect of different SL settings on strain recordings and the method's ability to detect transmural radial strain gradients.

METHODS

In 8 anesthetized pigs (mean weight 54 kg) epicardial echocardiography was performed. Strain analysis was carried out by defining the wall as a 1-, 2-, 3-, and 4-layer structure with suitable regions of interest. Peak ejection strain was measured with SL settings of 2 to 14 mm.

RESULTS

The systolic (ejection) strain showed large variation with SL. Sampling in one layer gave no significant reduction in strain for increasing SL. The strain in the subepicardial layer was low and decreased when the wall was divided into several layers (15.9 +/- 4.8% [2 layers]-2.1 +/- 2.4% [4 layers]; both measurements with SL = 4 mm). The method could separate 4 layers with SL of 4 mm or less, 3 layers with SL of 6 mm or less, and 2 layers with SL of 8 mm or less.

CONCLUSION

When measuring radial strain in the myocardial wall the SL must be low to evaluate transmural strain gradients. With correct settings of SL and region of interest, strain in 4 layers can be distinguished. As a rule of thumb the SL should be set to approximately half the systolic thickness of the wall or half the wall layer.