Monitoring imaging of lesions induced by high intensity focused ultrasound based on differential ultrasonic attenuation and integrated backscatter estimation

HIFU-induced changes in optical scattering and absorption of tissue over nine orders of thermal dose

The optical properties of tissue change during thermal ablation. Multi-modal methods such as acousto-optic (AO) and photo-acoustic (PA) imaging may provide a real-time, direct measure of lesion formation. Baseline changes in optical properties have been previously measured over limited ranges of thermal dose for tissues exposed to a temperature-controlled water bath, however, there is scant data for optical properties of lesions created by HIFU. In this work, the optical scattering and absorption coefficients from 400-1300 nm of excised chicken breast exposed to HIFU were measured using an integrating sphere spectrophotometric technique. HIFU-induced spatiotemporal temperature elevations were measured using an infrared camera and used to calculate the thermal dose delivered to a localized region of tissue. Results obtained over a range of thermal dose spanning 9 orders of magnitude show that the reduced scattering coefficient increases for HIFU exposures exceeding a threshold thermal dose of CEM₄₃  =  600  ±  81 cumulative equivalent minutes. HIFU-induced thermal damage results in changes in scattering over all optical wavelengths, with a 2.5-fold increase for thermal lesions exceeding 70 °C. The tissue absorption coefficient was also found to increase for thermally lesioned tissue, however, the magnitude was strongly dependent on the optical wavelength and there was substantial sample-to-sample variability, such that the existence of a threshold thermal dose could not be determined. Therapeutic windows, where the optical penetration depth is expected to be greatest, were identified in the near infrared regime centered near 900 nm and 1100 nm. These data motivate further research to improve the real-time AO and PA sensing of lesion formation during HIFU therapy as an alternative to thermometry.

High-Intensity Focused Ultrasound Thermal Lesion Detection Using Entropy Imaging of Ultrasound Radio Frequency Signal Time Series

Background:

During the past few decades, high-intensity focused ultrasound (HIFU) modality has been gaining surging interest in various therapeutic applications such as non- or minimally-invasive cancer treatment. Among other attributes, robust and real-time HIFU treatment monitoring and lesion detection have become essential issues for successful clinical acceptance of the modality. More recently, ultrasound radio frequency (RF) time series imaging has been studied by a number of researchers.

Materials and Methods:

The objective of this study is to investigate the applicability of entropy parameter of RF time series of ultrasound backscattered signals, a. k. a. Entropy imaging, toward HIFU thermal lesion detection. To this end, five fresh ex vivo porcine muscle tissue samples were exposed to HIFU exposures with total acoustic powers ranging from 30 to 110 Watts. The contrast-to-speckle ratio (CSR) values of the entropy images and their corresponding B-mode images of pre-, during- and post-HIFU exposure for each acoustic power were calculated.

Results:

The novelty of this study is the use of Entropy parameter on ultrasound RF time series for the first time. Statistically significant differences were obtained between the CSR values for the B mode and entropy images at various acoustic powers. In case of 110 Watt, a CSR value 3.4 times higher than B-mode images was accomplished using the proposed method. Furthermore, the proposed method is compared with the scaling parameter of Nakagami imaging and same data which are used in this study.

Conclusion:

Entropy has the potential for using as an imaging parameter for differentiating lesions in HIFU surgery.

Ex Vivo and In Vivo Monitoring and Characterization of Thermal Lesions by High-Intensity Focused Ultrasound and Microwave Ablation Using Ultrasonic Nakagami Imaging

The feasibility of ultrasonic Nakagami imaging to evaluate thermal lesions by high-intensity focused ultrasound and microwave ablation was explored in ex vivo and in vivo liver models. Dynamic changes of the ultrasonic Nakagami parameter in thermal lesions were calculated, and ultrasonic B-mode and Nakagami images were reconstructed simultaneously. The contrast-to-noise ratio (CNR) between thermal lesions and normal tissue was used to estimate the contrast resolution of the monitoring images. After thermal ablation, a bright hyper-echoic region appeared in the ultrasonic B-mode and Nakagami images, identifying the thermal lesion. During thermal ablation, mean values of Nakagami parameter showed an increasing trend from 0.72 to 1.01 for the ex vivo model and 0.54 to 0.72 for the in vivo model. After thermal ablation, mean CNR values of the ultrasonic Nakagami images were 1.29 dB (ex vivo) and 0.80 dB (in vivo), significantly higher ( ) than those for B-mode images. Thermal lesion size, assessed using ultrasonic Nakagami images, shows a good correlation to those obtained from the gross-pathology images (for the ex vivo model: length, = 0.96; width, = 0.90; for the in vivo model: length, = 0.95; width, = 0.85). This preliminary study suggests that ultrasonic Nakagami parameter may have a potential use in evaluating the formation of thermal lesions with better image contrast. Moreover, ultrasonic Nakagami imaging combined with B-mode imaging may be utilized as an alternative modality in developing monitoring systems for image-guided thermal ablation treatments.

Quantitative Ultrasound for Monitoring High-Intensity Focused Ultrasound Treatment In Vivo

The success of any minimally invasive treatment procedure can be enhanced significantly if combined with a robust noninvasive imaging modality that can monitor therapy in real time. Quantitative ultrasound (QUS) imaging has been widely investigated for monitoring various treatment responses such as chemotherapy, radiation, and thermal therapy. Previously, we demonstrated the feasibility of using spectral-based QUS parameters to monitor high-intensity focused ultrasound (HIFU) treatment of in situ tumors in euthanized rats [Ultrasonic Imaging 36(4), 239-255, 2014]. In the present study, we examined the use of spectral-based QUS parameters to monitor HIFU treatment of in vivo rat mammary adenocarcinoma tumors (MAT) where significant tissue motion was present. HIFU was applied to tumors in rats using a single-element transducer. During the off part of the HIFU duty cycle, ultrasound backscatter was recorded from the tumors using a linear array co-aligned with the HIFU focus. A total of 10 rats were treated with HIFU in this study with an additional sham-treated rat. Spectral parameters from the backscatter coefficient, i.e., effective scatterer diameter (ESD) and effective acoustic concentration (EAC), were estimated. The changes of each parameter during treatment were compared with a temperature profile recorded by a fine-needle thermocouple inserted into the tumor a few millimeters behind the focus of the HIFU transducer. The mean ESD changed from 121 ±6 to [Formula: see text], and the EAC changed from 33 ±2 to [Formula: see text] during HIFU exposure as the temperature increased on average from 38.7 ±1.0 (°)C to 64.2 ±2.7 (°)C. The changes in ESD and EAC were linearly correlated with the changes in tissue temperature during the treatment. When HIFU was turned off, the ESD increased from 81 ±8 to [Formula: see text] and the EAC dropped from 46 ±3 to 36±2 dB/cm(3) as the temperature decreased from 64.2 ±2.7 (°)C to 45 ±2.7 (°)C. QUS was demonstrated in vivo to track temperature elevations caused by HIFU exposure.

Real-time monitoring of high-intensity focused ultrasound thermal therapy using the manifold learning method

High-intensity focused ultrasound (HIFU) induces thermal lesions by increasing the tissue temperature in a tight focal region. The main ultrasound imaging techniques currently used to monitor HIFU treatment are standard pulse-echo B-mode ultrasound imaging, ultrasound temperature estimation and elastography-based methods. The present study was carried out on ex vivo animal tissue samples, in which backscattered radiofrequency (RF) signals were acquired in real time at time instances before, during and after HIFU treatment. The manifold learning algorithm, a non-linear dimensionality reduction method, was applied to RF signals whichconstruct B-mode images to detect the HIFU-induced changes among the image frames obtained during HIFU treatment. In this approach, the embedded non-linear information in the region of interest of sequential images is represented in a 2-D manifold with the Isomap algorithm, and each image is depicted as a point on the reconstructed manifold. Four distinct regions are chosen in the manifold corresponding to the four phases of HIFU treatment (before HIFU treatment, during HIFU treatment, immediately after HIFU treatment and 10-min after HIFU treatment). It was found that disorganization of the points is achieved by increasing the acoustic power, and if the thermal lesion has been formed, the regions of points related to pre- and post-HIFU significantly differ. Moreover, the manifold embedding was repeated on 2-D moving windows in RF data envelopes related to pre- and post-HIFU exposure data frames. It was concluded that if mean values of the points related to pre- and post-exposure frames in the reconstructed manifold are estimated, and if the Euclidean distance between these two mean values is calculated and the sliding window is moved and this procedure is repeated for the whole image, a new image based on the Euclidean distance can be formed in which the HIFU thermal lesion is detectable.

A survey of ultrasound elastography approaches to percutaneous ablation monitoring

Percutaneous thermal ablation has been widely used as a minimally invasive treatment for tumors. Treatment monitoring is essential for preventing complications while ensuring treatment efficacy. Mechanical testing measurements on tissue reveal that tissue stiffness increases with temperature and ablation duration. Different types of imaging methods can be used to monitor ablation procedures, including temperature or thermal strain imaging, strain imaging, modulus imaging, and shear modulus imaging. Ultrasound elastography demonstrates the potential to become the primary imaging modality for monitoring percutaneous ablation. This review briefly presented the state-of-the-art ultrasound elastography approaches for monitoring radiofrequency ablation and microwave ablation. These techniques were divided into four groups: quasi-static elastography, acoustic radiation force elastography, sonoelastography, and applicator motion elastography. Their advantages and limitations were compared and discussed. Future developments were proposed with respect to heat-induced bubbles, tissue inhomogeneities, respiratory motion, three-dimensional monitoring, multi-parametric monitoring, real-time monitoring, experimental data center for percutaneous ablation, and microwave ablation monitoring.

Enhanced lesion-to-bubble ratio on ultrasonic Nakagami imaging for monitoring of high-intensity focused ultrasound

OBJECTIVES

This work explored the feasibility of using ultrasonic Nakagami imaging to enhance the contrast between thermal lesions and bubbles induced by high-intensity focused ultrasound (US) in a transparent tissue-mimicking phantom at different acoustic power levels.

METHODS

The term "lesion-to-bubble ratio" was proposed and defined as the ratio of the scattered power from the thermal lesion to the scattered power from the bubbles calculated in the various monitoring of images for high-intensity focused US. Two-dimensional radiofrequency data backscattered from the exposed region were captured by a modified diagnostic US scanner to estimate the Nakagami statistical parameter, m, and reconstruct the ultrasonic B-mode images and Nakagami parameter images. The dynamic changes in the lesion-to-bubble ratio over the US exposure procedure were calculated simultaneously and compared among video photos, B-mode images, and Nakagami images for monitoring of high-intensity focused US.

RESULTS

After a small thermal lesion was induced by high-intensity focused US in the phantom, the lesion-to-bubble ratio values corresponding to the video photo, B-mode image, and Nakagami image were 5.3, 1, and 9.8 dB, respectively. When a large thermal lesion appeared in the phantom, the ratio values increased to 7.2, 3, and 14 dB. During US exposure, the ratio values calculated for the video photo, B-mode image, and Nakagami image began to increase gradually and rose to peak values of 8.3, 2.9, and 14.8 dB at the end of the US exposure.

CONCLUSIONS

This preliminary study on a tissue-mimicking phantom suggests that Nakagami imaging may have a potential use in enhancing the lesion-to-bubble ratio for monitoring high-intensity focused US. Further studies in vivo and in vitro will be needed to evaluate the potential applications for high-intensity focused US.

Mean scatterer spacing estimation in normal and thermally coagulated ex vivo bovine liver

The liver has been hypothesized to have a unique arrangement of microvasculature that presents as an arrangement of quasiperiodic scatterers to an interrogating ultrasound pulse. The mean scatterer spacing (MSS) of these quasiperiodic scatterers has been proposed as a useful quantitative ultrasound biomarker for characterizing liver tissue. Thermal ablation is an increasingly popular method for treating hepatic tumors, and ultrasonic imaging approaches for delineating the extent of thermal ablation are in high demand. In this work, we examine the distribution of estimated MSS in thermally coagulated bovine liver and normal untreated bovine liver ex vivo. We estimate MSS by detecting local maxima in the spectral coherence function of radio frequency echoes from a clinical transducer, the Siemens VFX 9L4 transducer operating on an S2000 scanner. We find that normal untreated bovine liver was characterized by an MSS of approximately 1.3 mm. We examined regions of interest 12 mm wide laterally, and ranging from 12 mm to 18 mm axially, in 2 mm increments. Over these parameters, the mode of the MSS estimates was between 1.25 and 1.37 mm. On the other hand, estimation of MSS in thermally coagulated liver tissue yields a distribution of MSS estimates whose mode varied between 0.45 and 1.0 mm when examining regions of interest over the same sizes. We demonstrate that the estimated MSS in thermally coagulated liver favors small spacings because the randomly positioned scatterers in this tissue are better modeled as aperiodic scatterers. The submillimeter spacings result from the fact that this was the most probable spacing to be estimated if the discretely sampled spectral coherence function was a uniformly random two-dimensional function.

In vivo thermal ablation monitoring using ultrasound echo decorrelation imaging

Previous work indicated that ultrasound echo decorrelation imaging can track and quantify changes in echo signals to predict thermal damage during in vitro radiofrequency ablation (RFA). In the in vivo studies reported here, the feasibility of using echo decorrelation imaging as a treatment monitoring tool was assessed. RFA was performed on normal swine liver (N = 5), and ultrasound ablation using image-ablate arrays was performed on rabbit liver implanted with VX2 tumors (N = 2). Echo decorrelation and integrated backscatter were computed from Hilbert transformed pulse-echo data acquired during RFA and ultrasound ablation treatments. Receiver operating characteristic (ROC) curves were employed to assess the ability of echo decorrelation imaging and integrated backscatter to predict ablation. Area under the ROC curves (AUROC) was determined for RFA and ultrasound ablation using echo decorrelation imaging. Ablation was predicted more accurately using echo decorrelation imaging (AUROC = 0.832 and 0.776 for RFA and ultrasound ablation, respectively) than using integrated backscatter (AUROC = 0.734 and 0.494).

Nakagami imaging for detecting thermal lesions induced by high-intensity focused ultrasound in tissue

High-intensity focused ultrasound induces focalized tissue coagulation by increasing the tissue temperature in a tight focal region. Several methods have been proposed to monitor high-intensity focused ultrasound-induced thermal lesions. Currently, ultrasound imaging techniques that are clinically used for monitoring high-intensity focused ultrasound treatment are standard pulse-echo B-mode ultrasound imaging, ultrasound temperature estimation, and elastography-based methods. On the contrary, the efficacy of two-dimensional Nakagami parametric imaging based on the distribution of the ultrasound backscattered signals to quantify properties of soft tissue has recently been evaluated. In this study, ultrasound radio frequency echo signals from ex vivo tissue samples were acquired before and after high-intensity focused ultrasound exposures and then their Nakagami parameter and scaling parameter of Nakagami distribution were estimated. These parameters were used to detect high-intensity focused ultrasound-induced thermal lesions. Also, the effects of changing the acoustic power of the high-intensity focused ultrasound transducer on the Nakagami parameters were studied. The results obtained suggest that the Nakagami distribution's scaling and Nakagami parameters can effectively be used to detect high-intensity focused ultrasound-induced thermal lesions in tissue ex vivo. These parameters can also be used to understand the degree of change in tissue caused by high-intensity focused ultrasound exposures, which could be interpreted as a measure of degree of variability in scatterer concentration in various parts of the high-intensity focused ultrasound lesion.

Tomographic reconstruction of tissue properties and temperature increase for high-intensity focused ultrasound applications

The acoustic and thermal properties as well as the temperature change within a tissue volume during high-intensity focused ultrasound ablation are critically important for treatment planning and monitoring. Described in this article is a tomographic reconstruction method used to determine the tissue properties and increase in temperature in a 3-D volume. On the basis of the iterative finite-element solution to the bioheat equation coupled with Tikhonov regularization techniques, our reconstruction algorithm solves the inverse problem of bioheat transfer and uses the time-dependent temperature measured on a tissue surface to obtain the acoustic absorption coefficient, thermal diffusivity and temperature increase within the subsurface volume. Numerical simulations were performed to validate the reconstruction algorithm. The method was initially conducted in ex vivo experiments in which time-dependent temperature on a tissue surface was measured using high-resolution, non-invasive infrared thermography.

Generation of uniform lesions in high intensity focused ultrasound ablation

High intensity focused ultrasound (HIFU) is emerging as an effective oncology treatment modality according to the clinical experience in the last decade. The temperature at the focus can reach over 65°C within seconds, denaturing cellular proteins and resulting in coagulative necrosis. HIFU parameters are usually kept the same for each treatment spot in tumor ablation. Because of the thermal diffusion from nearby spots, the lesion size will gradually increase as the HIFU therapy progresses, which leads to insufficient treatment of initial spots and over exposure of later ones. From the viewpoint of the physician, uniform lesions with the least energy exposure and the least energy are preferred in tumor ablation. In this study, an algorithm was developed to determine the number of HIFU pulses delivered to each spot in order to generate uniform lesions that fill the region-of-interest completely. The exposure energies required using different scanning pathways (raster scanning, spiral scanning from the center to the outside, and spiral scanning from the outside to the center), spot spacing (1mm, 2mm, 4mm, and 6mm) and motion time (from 0s to 400s) were compared with each other. It is found that spiral scanning from the outside to the center with spot spacing of 2mm and motion time less than 10s needs the least numbers of pulses or HIFU energy in uniform lesion production with the minimal temperature elevation. In addition, the effects of thermal properties of tissue (i.e., specific heat capacity, convective heat transfer coefficient, and thermal conductivity) on HIFU ablation were investigated in order to determine the HIFU treatment planning for various targets. Uniform lesion production in the transparent gel phantom and ex vivo bovine liver samples using the proposed algorithm proved effective and accord with the simulation for different scanning pathways by an extracorporeal clinical HIFU system. Therefore, dynamically adjusting ultrasound exposure energy can improve the efficacy and safety of HIFU ablation, and the treatment planning depends on the scanning protocol and thermal properties of the target.

Ultrasound-guided characterization of interstitial ablated tissue using RF time series: feasibility study

This paper presents the results of a feasibility study to demonstrate the application of ultrasound RF time series imaging to accurately differentiate ablated and nonablated tissue. For 12 ex vivo and two in situ tissue samples, RF ultrasound signals are acquired prior to, and following, high-intensity ultrasound ablation. Spatial and temporal features of these signals are used to characterize ablated and nonablated tissue in a supervised-learning framework. In cross-validation evaluation, a subset of four features extracted from RF time series produce a classification accuracy of 84.5%, an area under ROC curve of 0.91 for ex vivo data, and an accuracy of 85% for in situ data. Ultrasound RF time series is a promising approach for characterizing ablated tissue.

High-frequency rapid B-mode ultrasound imaging for real-time monitoring of lesion formation and gas body activity during high-intensity focused ultrasound ablation

The goal of this study was to examine the ability of high-frame-rate, high-resolution imaging to monitor tissue necrosis and gas-body activities formed during high-intensity focused ultrasound (HIFU) application. Ex vivo porcine cardiac tissue specimens (n = 24) were treated with HIFU exposure (4.33 MHz, 77 to 130 Hz pulse repetition frequency (PRF), 25 to 50% duty cycle, 0.2 to 1 s, 2600 W/cm(2)). RF data from B-mode ultrasound imaging were obtained before, during, and after HIFU exposure at a frame rate ranging from 77 to 130 Hz using an ultrasound imaging system with a center frequency of 55 MHz. The time history of changes in the integrated backscatter (IBS), calibrated spectral parameters, and echo-decorrelation parameters of the RF data were assessed for lesion identification by comparison against gross sections. Temporal maximum IBS with +12 dB threshold achieved the best identification with a receiver-operating characteristic (ROC) curve area of 0.96. Frame-to-frame echo decorrelation identified and tracked transient gas-body activities. Macroscopic (millimeter-sized) cavities formed when the estimated initial expansion rate of gas bodies (rate of expansion in lateral-to-beam direction) crossed 0.8 mm/s. Together, these assessments provide a method for monitoring spatiotemporal evolution of lesion and gas-body activity and for predicting macroscopic cavity formation.

Feasibility of using Nakagami distribution in evaluating the formation of ultrasound-induced thermal lesions

The acoustic posterior shadowing effects of bubbles influence the accuracy for defining the location and range of ablated thermal lesions during focused ultrasound surgery when using ultrasonic monitoring imaging. This paper explored the feasibility of using Nakagami distribution to evaluate the ablated region induced by focused ultrasound exposures at different acoustic power levels in transparent tissue-mimicking phantoms. The mean value of the Nakagami parameter m was about 0.5 in the cavitation region and increased to around 1 in the ablated region. Nakagami images were not subject to significant shadowing effects of bubbles. Ultrasound-induced thermal lesions observed in the photos and Nakagami images were overshadowed by bubbles in the B-mode images. The lesion size predicted in the Nakagami images was smaller than that predicted in the photos due to the sub resolvable effect of Nakagami imaging at the interface. This preliminary study on tissue-mimicking phantom suggested that the Nakagami parameter m may have the potential use in evaluating the formation of ultrasound-induced thermal lesion when the shadowing effect of bubbles is strong while the thermal lesion was small. Further studies in vivo and in vitro will be needed to evaluate the potential application.

High-frequency ultrasound m-mode imaging for identifying lesion and bubble activity during high-intensity focused ultrasound ablation

Effective real-time monitoring of high-intensity focused ultrasound (HIFU) ablation is important for application of HIFU technology in interventional electrophysiology. This study investigated rapid, high-frequency M-mode ultrasound imaging for monitoring spatiotemporal changes during HIFU application. HIFU (4.33 MHz, 1 kHz PRF, 50% duty cycle, 1 s, 2600‒6100 W/cm²) was applied to ex vivo porcine cardiac tissue specimens with a confocally and perpendicularly aligned high-frequency imaging system (Visualsonics Vevo 770, 55 MHz center frequency). Radio-frequency (RF) data from M-mode imaging (1 kHz PRF, 2 s × 7 mm) was acquired before, during and after HIFU treatment (n = 12). Among several strategies, the temporal maximum integrated backscatter with a threshold of +12 dB change showed the best results for identifying final lesion width (receiver-operating characteristic curve area 0.91 ± 0.04, accuracy 85 ± 8%, compared with macroscopic images of lesions). A criterion based on a line-to-line decorrelation coefficient is proposed for identification of transient gas bodies.

A fast tissue stiffness-dependent elastography for HIFU-induced lesions inspection

To monitor HIFU-induced lesion with elastography in quasi-real time, a fast correlation based elastographic algorithm using tissue stiffness-dependent displacement estimation (SdDE) is developed in this paper. The high time efficiency of the proposed method contributes to the reduction on both the number of the displacement points and the computational time of most of the points by utilizing local uniformity of the tissue under HIFU treatment. To obtain admirable comprehensive performance, the key algorithm parameter, a threshold to densify the displacement points, is optimized with simulation over a wedge-inclusion tissue model by compromising the axial resolution (AR) and the computational cost. With the optimum parameter, results from both simulations and phantom experiments show that the SdDE is faster in about one order of magnitude than the traditional correlation based algorithm. At the same time, other performance parameters, such as the signal-to-noise ratio (SNRe), the contrast-to-noise ratio (CNRe) and the axial resolution (AR), are superior to or comparable with that obtained from the traditional algorithm. In vitro experiments on bovine livers validate the improvement on the time efficiency under the circumstances of real tissue and real radio frequency (RF) signal. This preliminary work implies potential of the SdDE in dynamic or close real time guidance and monitoring of HIFU treatment.

Monitoring of thermal therapy based on shear modulus changes: I. shear wave thermometry

The clinical applicability of high-intensity focused ultrasound (HIFU) for noninvasive therapy is today hampered by the lack of robust and real-time monitoring of tissue damage during treatment. The goal of this study is to show that the estimation of local tissue elasticity from shear wave imaging (SWI) can lead to the 2-D mapping of temperature changes during HIFU treatments. This new concept of shear wave thermometry is experimentally implemented here using conventional ultrasonic imaging probes. HIFU treatment and monitoring were, respectively, performed using a confocal setup consisting of a 2.5-MHz single-element transducer focused at 30 mm on ex vivo samples and an 8-MHz ultrasound diagnostic probe. Thermocouple measurements and ultrasound-based thermometry were used as a gold standard technique and were combined with SWI on the same device. The SWI sequences consisted of 2 successive shear waves induced at different lateral positions. Each wave was created using 100-μs pushing beams at 3 depths. The shear wave propagation was acquired at 17,000 frames/s, from which the elasticity map was recovered. HIFU sonications were interleaved with fast imaging acquisitions, allowing a duty cycle of more than 90%. Elasticity and temperature mapping was achieved every 3 s, leading to realtime monitoring of the treatment. Tissue stiffness was found to decrease in the focal zone for temperatures up to 43°C. Ultrasound-based temperature estimation was highly correlated to stiffness variation maps (r² = 0.91 to 0.97). A reversible calibration phase of the changes of elasticity with temperature can be made locally using sighting shots. This calibration process allows for the derivation of temperature maps from shear wave imaging. Compared with conventional ultrasound-based approaches, shear wave thermometry is found to be much more robust to motion artifacts.

Current status of clinical high-intensity focused ultrasound

High-intensity focused ultrasound (HIFU) is being promoted as a noninvasive method to treat certain primary solid tumors, metastatic disease, and enhance drug delivery. The field of medicine is evolving towards increasing use of noninvasive and minimally invasive therapies such as HIFU. This article provides an overview of current clinical applications of HIFU and future requirements to expand the clinical applications of this technique.

Improved algorithm for estimation of attenuation along propagation path using backscattered echoes from multiple sources

Accurately determining the attenuation along the propagation path leading to a region of interest could significantly improve diagnostic ultrasound tissue characterization since tissue characterization requires exact compensation for the frequency-dependent attenuation along the propagation path. In a previous study (JASA, 124:1367, 2008), it was shown that the total attenuation can be determined by using the backscattered echoes from multiple sources. The preliminary computer simulation results, had an average error between -0.3 and +0.2dB/MHz for the cases tested with a trend towards increasing error with increasing correlation length (i.e., characteristic size of the tissue microstructure of the scattering medium) and attenuation along the propagation path. Therefore, the goal of this study was to improve the accuracy of previously derived algorithm and reduce the dependence of the algorithm on correlation length and attenuation. In this study, the previous derivations were redone and the assumptions made by the algorithm regarding the scattering properties of the medium and the shape of the backscattered power spectrum were relaxed. The revised algorithm was then verified using computer simulations of five sources (6, 8, 10, 12, and 14MHz, 50% bandwidth) exposing a homogeneous tissue region. The simulated tissue had microstructure following a Gaussian spatial correlation function (i.e., exp(-0.827(ka(eff))(2)) where k is the wavenumber) with effective radii, a(eff), of 5-55microm (one size per simulated case) placed at a density of 250/mm(3) ( approximately 5 scatterers/resolution cell for 14MHz transducer). The attenuation of the tissue was also varied from 0.1 to 0.9dB/cm-MHz. The computer simulations demonstrated that the modifications significantly improved the accuracy of the algorithm resulting in average errors between -0.04 and 0.1dB/MHz which is three times better than the error performance of the original algorithm.

Model-based ultrasound temperature visualization during and following HIFU exposure

This paper describes the application of signal processing techniques to improve the robustness of ultrasound feedback for displaying changes in temperature distribution in treatment using high-intensity focused ultrasound (HIFU), especially at the low signal-to-noise ratios that might be expected in in vivo abdominal treatment. Temperature estimation is based on the local displacements in ultrasound images taken during HIFU treatment, and a method to improve robustness to outliers is introduced. The main contribution of the paper is in the application of a Kalman filter, a statistical signal processing technique, which uses a simple analytical temperature model of heat dispersion to improve the temperature estimation from the ultrasound measurements during and after HIFU exposure. To reduce the sensitivity of the method to previous assumptions on the material homogeneity and signal-to-noise ratio, an adaptive form is introduced. The method is illustrated using data from HIFU exposure of ex vivo bovine liver. A particular advantage of the stability it introduces is that the temperature can be visualized not only in the intervals between HIFU exposure but also, for some configurations, during the exposure itself.

Dynamic changes of integrated backscatter, attenuation coefficient and bubble activities during high-intensity focused ultrasound (HIFU) treatment

This paper simultaneously investigated the transient characteristics of integrated backscatter (IBS), attenuation coefficient and bubble activities as time traces before, during and after HIFU treatment, with different HIFU parameters (acoustic power and duty cycle) in both transparent tissue-mimicking phantoms and freshly excised bovine livers. These dynamic changes of acoustic parameters and bubble activities were correlated with the visualization of lesion development selected from photos, conventional B-mode ultrasound images and differential IBS images over the whole procedure of HIFU treatment. Two-dimensional radiofrequency (RF) data were acquired by a modified diagnostic ultrasound scanner to estimate the changes of mean IBS and attenuation coefficient averaged in the lesion region, and to construct the differential IBS images and B-mode ultrasound images simultaneously. Bubble activities over the whole procedure of HIFU treatment were investigated by the passive cavitation detection (PCD) method and the changes in subharmonic and broadband noise were correlated with the transient characteristics of IBS and attenuation coefficient. When HIFU was switched on, IBS and attenuation coefficient increased with the appearance of bubble clouds in the B-mode and differential IBS image. At the same time, the level of subharmonic and broadband noise rose abruptly. Then, there was an initial decrease in the attenuation coefficient, followed by an increase when at lower HIFU power. As the lesion appeared, IBS and attenuation coefficient both increased rapidly to a value twice that of normal. Then the changes in IBS and attenuation coefficient showed more complex patterns, but still showed a slower trend of increases with lesion development. Violent bubble activities were visible in the gel and were evident as strongly echogenic regions in the differential IBS images and B-mode images simultaneously. This was detected by a dramatic high level of subharmonic and broadband noise at the same time. These bubble activities caused fluctuations in IBS and attenuation coefficient during HIFU treatment. After HIFU, IBS and attenuation coefficient decreased gradually accompanied by the fadeout of bright hyperechoic spot in the B-mode and differential IBS image, but were still higher than normal when they were stable. The increases of IBS and attenuation coefficient were greater when using higher acoustic power or a higher duty cycle of the therapeutic emission. These experiments indicated that the bubble activities had the dominant effects on the transient characteristics of IBS and attenuation. This should be taken into consideration when using the dynamic acoustic-property changes for the potentially real-time monitoring imaging of HIFU treatment.

Ultrasound monitoring of in vitro radio frequency ablation by echo decorrelation imaging

OBJECTIVE

The purpose of this study was to test ultrasound echo decorrelation imaging for mapping and characterization of tissue effects caused by radio frequency ablation (RFA).

METHODS

Radio frequency ablation procedures (6-minute duration, 20-W power) were performed on fresh ex vivo bovine liver tissue (n = 9) with continuous acquisition of beam-formed ultrasound echo data from a 7-MHz linear array. Echo data were processed to form B-scan images, echo decorrelation images (related to rapid random changes in echo waveforms), and integrated backscatter images (related to local changes in received echo energy). Echo decorrelation and integrated backscatter values at the location of a low-noise thermocouple were assessed as functions of temperature. Echo decorrelation and integrated backscatter images were directly compared with ablated tissue cross sections and quantitatively evaluated as predictors of tissue ablation and overtreatment.

RESULTS

Echo decorrelation maps corresponded with local tissue temperature and ablation effects. Consistent echo decorrelation increases were observed for temperatures above 75 degrees C, whereas integrated backscatter maps showed a nonmonotonic temperature dependence complicated by acoustic shadowing, with high variance at large temperature elevations. In receiver operating characteristic curve analysis of echo decorrelation and integrated backscatter maps as predictors of local tissue ablation, echo decorrelation performed well (area under the receiver operating characteristic curve [AUROC] = 0.855 for ablation and 0.913 for overtreatment), whereas integrated backscatter performed poorly (AUROC < 0.6).

CONCLUSIONS

Echo decorrelation imaging can map tissue changes due to RFA in vitro, with local echo decorrelation corresponding strongly to local tissue temperature elevations and ablation effects. With further development and in vivo validation, echo decorrelation imaging is potentially useful for improved image guidance of clinical RFA procedures.

Shape-based ultrasound tomography using a Born model with application to high intensity focused ultrasound therapy

A shaped-based ultrasound tomography method is proposed to reconstruct ellipsoidal objects using a linearized scattering model. The method is motivated by the desire to detect the presence of lesions created by high intensity focused ultrasound (HIFU) in applications of cancer therapy. The computational size and limited view nature of the relevant three-dimensional inverse problem renders impractical the use of traditional pixel-based reconstruction methods. However, by employing a shape-based parametrization it is only necessary to estimate a small number of unknowns describing the geometry of the lesion, in this paper assumed to be ellipsoidal. The details of the shape-based nonlinear inversion method are provided. Results obtained from a commercial ultrasound scanner and a tissue phantom containing a HIFU-like lesion demonstrate the feasibility of the approach where a 20 mm x 5 mm x 6 mm ellipsoidal inclusion was detected with an accuracy of around 5%.