Reduction of stress nonuniformities by apodization of compressor displacement in elastography

A Quasi-Static Quantitative Ultrasound Elastography Algorithm Using Optical Flow

Ultrasound elastography is a constantly developing imaging technique which is capable of displaying the elastic properties of tissue. The measured characteristics could help to refine physiological tissue models, but also indicate pathological changes. Therefore, elastography data give valuable insights into tissue properties. This paper presents an algorithm that measures the spatially resolved Young’s modulus of inhomogeneous gelatin phantoms using a CINE sequence of a quasi-static compression and a load cell measuring the compressing force. An optical flow algorithm evaluates the resulting images, the stresses and strains are computed, and, conclusively, the Young’s modulus and the Poisson’s ratio are calculated. The whole algorithm and its results are evaluated by a performance descriptor, which determines the subsequent calculation and gives the user a trustability index of the modulus estimation. The algorithm shows a good match between the mechanically measured modulus and the elastography result—more precisely, the relative error of the Young’s modulus estimation with a maximum error 35%. Therefore, this study presents a new algorithm that is capable of measuring the elastic properties of gelatin specimens in a quantitative way using only the image data. Further, the computation is monitored and evaluated by a performance descriptor, which measures the trustability of the results.

Toward Quantitative and Operator-independent Quasi-static Ultrasound Elastography: An Ex Vivo Feasibility Study

It is known that the elasticity of liver reduces progressively in the case of diffuse liver disease. Currently, the diagnosis of diffuse liver disease requires a biopsy, which is an invasive procedure. In this paper, we evaluate and report a noninvasive method that can be used to quantify liver stiffness using quasi-static ultrasound elastography approach. Quasi-static elastography is popular in clinical applications where the qualitative assessment of relative tissue stiffness is enough, whereas its potential is relatively underutilized in liver imaging due to lack of local stiffness contrast in the case of diffuse liver disease. Recently, we demonstrated an approach of using a calibrated reference layer to produce quantitative modulus elastograms of the target tissue in simulations and phantom experiments. In a separate work, we reported the development of a compact handheld device to reduce inter- and intraoperator variability in freehand elastography. In this work, we have integrated the reference layer with a handheld controlled compression device and evaluate it for quantitative liver stiffness imaging application. The performance of this technique was assessed on ex vivo goat liver samples. The Young's modulus values obtained from indentation measurements of liver samples acted as the ground truth for comparison. The results from this work demonstrate that by combining the handheld device along with reference layer, the estimated Young's modulus value approaches the ground truth with less error compared with that obtained using freehand compression (8% vs. 15%). The results suggest that the intra- and interoperator reproducibility of the liver elasticity also improved when using the handheld device. Elastography with a handheld compression device and reference layer is a reliable and simple technique to provide a quantitative measure of elasticity.

Development of a training phantom for compression breast elastography-comparison of various elastography systems and numerical simulations

The elastic properties of tissue are related to tissue composition and pathological changes. It has been observed that many pathological processes increase the elastic modulus of soft tissue compared to normal. Ultrasound compression elastography is a method of characterization of elastic properties that has been the focus of many research efforts in the last two decades. In medical radiology, compression elastography is provided as an additional tool with ultrasound B-mode in the existing scanners, and the combined features of elastography and echography act as a promising diagnostic method in breast cancer detection. However, the full capability of the ultrasound elastography technique together with B-mode has not been utilized by novice radiologists due to the nonavailability of suitable, appropriately designed tissue-mimicking phantoms. Since different commercially available ultrasound elastographic scanners follow their own unique protocols, training novice radiologists is becoming cumbersome. The main focus of this work is to develop a tissue-like agar-based phantom, which mimics breast tissue with common abnormal lesions like fibroadenoma and invasive ductal carcinoma in a clinically perceived way and compares the sonographic and elastographic appearances using different commercially available systems. In addition, the developed phantoms are simulated using the finite-element method, and ideal strain images are generated. Strain images from experiment and simulation are compared based on image contrast parameters, namely contrast transfer efficiency (CTE) and observed strain, and they are in good agreement. The strain image contrast of malignant inclusions is significantly improved compared to benign inclusions, and the trend of CTE is similar for all elastographic scanners under investigation.

Quantitative imaging of nonlinear shear modulus by combining static elastography and shear wave elastography

The study of new tissue mechanical properties such as shear nonlinearity could lead to better tissue characterization and clinical diagnosis. This work proposes a method combining static elastography and shear wave elastography to derive the nonlinear shear modulus by applying the acoustoelasticity theory in quasi-incompressible soft solids. Results demonstrate that by applying a moderate static stress at the surface of the investigated medium, and by following the quantitative evolution of its shear modulus, it is possible to accurately and quantitatively recover the local Landau (A) coefficient characterizing the shear nonlinearity of soft tissues.

Model-based elastography: a survey of approaches to the inverse elasticity problem

Elastography is emerging as an imaging modality that can distinguish normal versus diseased tissues via their biomechanical properties. This paper reviews current approaches to elastography in three areas--quasi-static, harmonic and transient--and describes inversion schemes for each elastographic imaging approach. Approaches include first-order approximation methods; direct and iterative inversion schemes for linear elastic; isotropic materials and advanced reconstruction methods for recovering parameters that characterize complex mechanical behavior. The paper's objective is to document efforts to develop elastography within the framework of solving an inverse problem, so that elastography may provide reliable estimates of shear modulus and other mechanical parameters. We discuss issues that must be addressed if model-based elastography is to become the prevailing approach to quasi-static, harmonic and transient elastography: (1) developing practical techniques to transform the ill-posed problem with a well-posed one; (2) devising better forward models to capture the complex mechanical behavior of soft tissues and (3) developing better test procedures to evaluate the performance of modulus elastograms.

Medical ultrasound: imaging of soft tissue strain and elasticity

After X-radiography, ultrasound is now the most common of all the medical imaging technologies. For millennia, manual palpation has been used to assist in diagnosis, but it is subjective and restricted to larger and more superficial structures. Following an introduction to the subject of elasticity, the elasticity of biological soft tissues is discussed and published data are presented. The basic physical principles of pulse-echo and Doppler ultrasonic techniques are explained. The history of ultrasonic imaging of soft tissue strain and elasticity is summarized, together with a brief critique of previously published reviews. The relevant techniques-low-frequency vibration, step, freehand and physiological displacement, and radiation force (displacement, impulse, shear wave and acoustic emission)-are described. Tissue-mimicking materials are indispensible for the assessment of these techniques and their characteristics are reported. Emerging clinical applications in breast disease, cardiology, dermatology, gastroenterology, gynaecology, minimally invasive surgery, musculoskeletal studies, radiotherapy, tissue engineering, urology and vascular disease are critically discussed. It is concluded that ultrasonic imaging of soft tissue strain and elasticity is now sufficiently well developed to have clinical utility. The potential for further research is examined and it is anticipated that the technology will become a powerful mainstream investigative tool.

Estimating axial and lateral strain using a synthetic aperture elastographic imaging system

Model-based elastography is an emerging technique with clinical applications in imaging vascular tissues, guiding minimally invasive therapies and diagnosing breast and prostate cancers. Its usage is limited because ultrasound can measure only the axial component of displacement with high precision. The goal of this study was to assess the effect of lateral sampling frequency, lateral beam-width and the number of active transmission elements on the quality of axial and lateral strain elastograms. Elastographic imaging was performed on gelatin-based phantoms with a modified commercial ultrasound scanner. Three groups of radio-frequency (RF) echo frames were reconstructed from fully synthetic aperture data. In the first group, all 128 transmission elements (corresponding to a lateral beamwidth of 0.22 mm at the center of the field of view) were used to reconstruct RF echo frames with A-line densities that varied from 6.4 lines/mm to 51.2 lines/mm. In the second group, the size of the aperture was varied to produce RF echo frames with lateral beamwidths ranging from 0.22 mm to 0.43 mm and a fixed A-line density of 25.6 lines/mm. In the third group, sparse arrays with varying number of active transmission elements (from 2 to 128) were used to reconstruct RF echo frames, whose A-line density and lateral beamwidth were fixed to 25.6 lines/mm and 0.22 mm, respectively. Applying a two-dimensional (2-D) displacement estimator to the pre- and post-deformed RF echo frames produced displacement elastograms. Axial and lateral strain elastograms were computed from displacement elastograms with a least squares strain estimator. The quality of axial and lateral strain elastograms improved with increasing applied strain and A-line density but decreased with increasing lateral beamwidth and deteriorated as the number of active transmission elements in the sparse arrays were reduced. This work demonstrated that the variance incurred when estimating the lateral component of displacement was reduced considerably when elastography was performed with a synthetic aperture ultrasound imaging system. Satisfactory axial and lateral strain elastograms were produced using a sparse array with as few as 16 active transmission elements.

Elastography for the follow-up of high-intensity focused ultrasound prostate cancer treatment: initial comparison with MRI

We previously developed an ultrasonic elastography imaging system that may provide a simple and cost-effective solution to monitor high-intensity focused ultrasound (HIFU) treatments. The objective of this clinical study was to evaluate the reliability of our system in assessing the volume of HIFU lesions in the prostate, using a comparison with magnetic resonance imaging (MRI). Elastograms were obtained in 20 patients after HIFU treatment for prostate cancer and gadolinium-enhanced T1- and T2-weighted MRI was performed. Lesion boundaries were manually outlined and the volume was calculated. A statistically significant correlation of rho = 0.62 (p = 0.022) was found between elastographic and MRI measurements of lesion volume, with elastographic measurements that generally underestimated the volume measured in MRI. Some basic physics (hypoechoic areas) and instrumentation (frame rate and band width) issues that were detrimental to image quality in vivo are reported, along with propositions to improve the technique. Because of these issues and, although good correspondence between elastographic and MRI measurements was found in some patients, elastographic measurements were unable to predict MRI measurements in a single individual. Nevertheless, the results confirmed the potential of elastography for monitoring HIFU treatment of the prostate. Further investigation will be conducted using better suited ultrasound equipment and performing real-time elastogram calculations.

Comparative evaluation of strain-based and model-based modulus elastography

Elastography based on strain imaging currently endures mechanical artefacts and limited contrast transfer efficiency. Solving the inverse elasticity problem (IEP) should obviate these difficulties; however, this approach to elastography is often fraught with problems because of the ill-posed nature of the IEP. The aim of the present study was to determine how the quality of modulus elastograms computed by solving the IEP compared with those produced using standard strain imaging methodology. Strain-based modulus elastograms (i.e., modulus elastograms computed by simply inverting strain elastograms based on the assumption of stress uniformity) and model-based modulus elastograms (i.e., modulus elastograms computed by solving the IEP) were computed from a common cohort of simulated and gelatin-based phantoms that contained inclusions of varying size and modulus contrast. The ensuing elastograms were evaluated by employing the contrast-to-noise ratio (CNR(e)) and the contrast transfer efficiency (CTE(e)) performance metrics. The results demonstrated that, at a fixed spatial resolution, the CNR(e) of strain-based modulus elastograms was statistically equivalent to those computed by solving the IEP. At low modulus contrast, the CTE(e) of both elastographic imaging approaches was comparable; however, at high modulus, the CTE(e) of model-based modulus elastograms was superior.

Visualisation of HIFU lesions using elastography of the human prostate in vivo: preliminary results

An imaging system was developed for prostate elastography in vivo using a transrectal ultrasound (US) probe to guide high-intensity focused US (HIFU) therapy of prostate cancer. Uniform compression was applied using a balloon, while a sector image was acquired. Strain was calculated from the gradient of the displacements obtained from the ultrasonic signal using the cross-correlation technique. Elastograms were acquired on a total of 31 patients undergoing HIFU therapy for localised prostate cancer. For two patients, only part of the prostate was treated and posttherapy magnetic resonance imaging (MRI) confirmed the size and position of the HIFU lesions seen in the elastograms as low strain areas, with a strain contrast ratio between 1.6 and 3.2. The whole prostate was treated for the next 29 patients. After treatment, the whole prostate appeared to be stiff in the elastograms and a 40% to 60% (mean 50%) decrease in average strain was observed when compared to strains measured before HIFU application. Tumours identified by biopsies and sonograms could occasionally be seen in the preoperative elastograms. Decorrelation effects occurred mainly because of low sonographic signal-to-noise ratio (SNR) and of out-of-plane motion induced by respiration.

A modified block matching method for real-time freehand strain imaging

This manuscript reports a technical innovation that has been developed for real-time, freehand strain imaging. This work is based on a well-known block-matching algorithm with two significant modifications. First, since displacements are estimated row-by-row, displacement estimates from the previous row are used to predict the displacement estimates in the current row, thereby drastically reducing the search-region size and increasing computational efficiency. Second, a displacement error detection and correction method is developed to overcome the local tracking errors that may be more severe with freehand scanning and thereby improve the robustness of the algorithm. This algorithm has been implemented on a clinical ultrasound imaging system, and with real-time imaging feedback, long sequences of high quality strain images are observed using freehand compression. Displacement estimation errors with this method are experimentally measured and compared with results from simulation. We report only a specific implementation, with no comparison to other displacement estimators in the literature and no optimization of this specific technique. Images of tissue-mimicking phantoms with small spherical targets are used to test the ability to detect small lesions using the strain imaging technique. In vivo strain images of breast and thyroid are also shown.

Influence of catheter position on estimated strain in intravascular elastography

In elastography, an erroneous strain estimate is obtained when the radial strain and the probing ultrasound beam are not properly aligned: the "strain projection artifact". In practice, an angle between the strain and the ultrasound beam will be present in most of the cases due to inhomogeneities or nonuniform compression. In this study, a theoretical function describing the strain projection artifact is derived as a function of the angle between the radial strain and the ultrasound beam. Two main factors for an angle between strain and ultrasound beam in intravascular elastographic experiments are eccentricity and tilt of the transducer. The theoretical functions describing these errors are corroborated with strain estimates from an experiment with a circular, homogeneous gel-based vessel phantom. Comparison between the theoretical functions and the experimental results reveals that the strain projection artifact is well described by the theoretical findings. As a result, the experimental data can be corrected for this artifact. The corrected elastograms reveal that correct strain estimates are obtained when the eccentricity of the intravascular catheter is less than 63%. An "off-the-wall" device may be required to advance intravascular elastography to in vivo implementation.