High-frequency ultrasound for quantitative characterization of myocardial edema

Spatiotemporal Coherence Weighting for In Vivo Cardiac Photoacoustic Image Beamformation

Photoacoustic (PA) image reconstruction generally utilizes delay-and-sum (DAS) beamforming of received acoustic waves from tissue irradiated with optical illumination. However, nonadaptive DAS reconstructed cardiac PA images exhibit temporally varying noise which causes reduced myocardial PA signal specificity, making image interpretation difficult. Adaptive beamforming algorithms such as minimum variance (MV) with coherence factor (CF) weighting have been previously reported to improve the DAS image quality. In this article, we report on an adaptive beamforming algorithm by extending CF weighting to the temporal domain for preclinical cardiac PA imaging (PAI). The proposed spatiotemporal coherence factor (STCF) considers multiple temporally adjacent image acquisition events during beamforming and cancels out signals with low spatial coherence and temporal coherence, resulting in higher background noise cancellation while preserving the main features of interest (myocardial wall) in the resultant PA images. STCF has been validated using the numerical simulations and in vivo ECG and respiratory-signal-gated cardiac PAI in healthy murine hearts. The numerical simulation results demonstrate that STCF weighting outperforms DAS and MV beamforming with and without CF weighting under different levels of inherent contrast, acoustic attenuation, optical scattering, and signal-to-noise (SNR) of channel data. Performance improvement is attributed to higher sidelobe reduction (at least 5 dB) and SNR improvement (at least 10 dB). Improved myocardial signal specificity and higher signal rejection in the left ventricular chamber and acoustic gel region are observed with STCF in cardiac PAI.

Myocardial Fluid Balance and Pathophysiology of Myocardial Edema in Coronary Artery Bypass Grafting

Myocardial edema is one of the most common complications of coronary artery bypass grafting (CABG) that is linearly related to many coronary artery diseases. Myocardial edema can cause several consequences including systolic dysfunction, diastolic dysfunction, arrhythmia, and cardiac tissue fibrosis that can increase mortality in CABG. Understanding myocardial fluid balance and tissue and systemic fluid regulation is crucial in order to ultimately link how coronary artery bypass grafting can cause myocardial edema in such a setting. The identification of susceptible patients by using imaging modalities is still challenging. Future studies about the technique of imaging modalities, examination protocols, prevention, and treatment of myocardial edema should be carried out, in order to limit myocardial edema occurrence and prevent complications.

Myocardial Tissue Characterization and Fibrosis by Imaging

Myocardial fibrosis, either focal or diffuse, is a common feature of many cardiac diseases and is associated with a poor prognosis for major adverse cardiovascular events. Although histological analysis remains the gold standard for confirming the presence of myocardial fibrosis, endomyocardial biopsy is invasive, has sampling errors, and is not practical in the routine clinical setting. Cardiac imaging modalities offer noninvasive surrogate biomarkers not only for fibrosis but also for myocardial edema and infiltration to varying degrees, and have important roles in the diagnosis and management of cardiac diseases. This review summarizes important pathophysiological features in the development of commonly encountered cardiac diseases, and the principles, advantages, and disadvantages of various cardiac imaging modalities (echocardiography, single-photon emission computer tomography, positron emission tomography, multidetector computer tomography, and cardiac magnetic resonance) for myocardial tissue characterization, with an emphasis on imaging focal and diffuse myocardial fibrosis.

Velocimetric ultrasound thermometry applied to myocardium protection monitoring

Tissue temperature control during cardiac surgery is crucial for myocardial protection. To preserve the tissue, a hypothermic cardioplegia is applied in order to decrease the heart temperature down to around 10°C. The monitoring of the thermal evolution of the myocardium is then of importance to minimize deleterious effects on the heart. The present work aims at evaluating the potential of an ultrasonic velocimetric thermometry on the monitoring of in vitro tissues heating. An indentation process is first proposed to identify the experimental linear relationship linking, in myocardia, the speed of the ultrasonic longitudinal wave to the tissue temperature. An extension of this method based on the echo-tracking principle is then proposed to approach surgical conditions. Temperature changes are measured by monitoring the induced time delays of backscattered ultrasonic echoes. These results are compared to T-type thermocouple reference measurements. They are then discussed in terms of measurement precision and in situ applications.

Poly(vinyl alcohol) gel ultrasound phantom with durability and visibility of internal flow

PURPOSE

Among various existing flow phantoms, none is characterized by appropriate acoustic, visibility, and durability properties simultaneously. The aim of this study was to develop a durable ultrasound phantom with visibility of the internal flow.

METHODS

Poly(vinyl alcohol) (PVA) gel was chosen as the basic material. The acoustic properties of various PVA gels were measured with 40-MHz ultrasound, the compositions of PVA, dimethyl sulfoxide (DMSO), and glass microbeads being changed, while visually checking the transparency. Wall-less ultrasound flow phantoms with a straight channel 2 mm in diameter were made from PVA gel, and ultrasound B-mode imaging was conducted with blood-mimicking fluid flow.

RESULTS

The acoustic properties of in vivo soft tissue were reproduced by PVA gel with a PVA concentration of 15 mass% and a glass microbead concentration of 2.9 mass% in a solvent of 98 mol% DMSO, showing acoustic properties of 1567 ± 4 m/s and 56 ± 5 dB/cm. The PVA gel was durable with visibility of the flow in the ultrasound phantom. The ultrasound B-mode image of the ultrasound flow phantom showed features approximating those of a mouse carotid artery.

CONCLUSION

A durable PVA gel ultrasound phantom with visibility of the internal flow was developed.

An inverse finite element method for determining the tissue compressibility of human left ventricular wall during the cardiac cycle

The determination of the myocardium's tissue properties is important in constructing functional finite element (FE) models of the human heart. To obtain accurate properties especially for functional modeling of a heart, tissue properties have to be determined in vivo. At present, there are only few in vivo methods that can be applied to characterize the internal myocardium tissue mechanics. This work introduced and evaluated an FE inverse method to determine the myocardial tissue compressibility. Specifically, it combined an inverse FE method with the experimentally-measured left ventricular (LV) internal cavity pressure and volume versus time curves. Results indicated that the FE inverse method showed good correlation between LV repolarization and the variations in the myocardium tissue bulk modulus K (K = 1/compressibility), as well as provided an ability to describe in vivo human myocardium material behavior. The myocardium bulk modulus can be effectively used as a diagnostic tool of the heart ejection fraction. The model developed is proved to be robust and efficient. It offers a new perspective and means to the study of living-myocardium tissue properties, as it shows the variation of the bulk modulus throughout the cardiac cycle.

Detection of progressive myocardial tissue injury by ultrasonic integrated backscatter immediately after coronary reperfusion

Myocardial reperfusion following ischemia may paradoxically cause additional injury, including microvascular damage and edema. These structural alterations augment tissue echogenicity, which is measurable by ultrasonic integrated backscatter (IB). We sought to characterize alterations in myocardial IB in an ischemic and reperfused region of the rat heart. Myocardial IB of the regions of interest in 12 adult male Sprague-Dawley rats was studied at baseline, during ischemia, and chronologically after coronary reopening, using an ultrasound frequency of 8 MHz. IB did not significantly change between baseline and ischemia. However, within 1 min of reperfusion, IB significantly increased and continued to increase until 10 min of reperfusion, when a plateau was reached. Areas of high echogenicity were comparable to infarcted areas on gross pathologic slices and had edema with extravasation of red blood cells. Myocardial reperfusion following ischemia significantly augments tissue echogenicity. A continuing increase of IB suggests a rapid progression of reperfusion injury.

T2-weighted cardiovascular magnetic resonance in acute cardiac disease

Cardiovascular magnetic resonance (CMR) using T2-weighted sequences can visualize myocardial edema. When compared to previous protocols, newer pulse sequences with substantially improved image quality have increased its clinical utility. The assessment of myocardial edema provides useful incremental diagnostic and prognostic information in a variety of clinical settings associated with acute myocardial injury. In patients with acute chest pain, T2-weighted CMR is able to identify acute or recent myocardial ischemic injury and has been employed to distinguish acute coronary syndrome (ACS) from non-ACS as well as acute from chronic myocardial infarction.T2-weighted CMR can also be used to determine the area at risk in reperfused and non-reperfused infarction. When combined with contrast-enhanced imaging, the salvaged area and thus the success of early coronary revascularization can be quantified. Strong evidence for the prognostic value of myocardial salvage has enabled its use as a primary endpoint in clinical trials. The present article reviews the current evidence and clinical applications for T2-weighted CMR in acute cardiac disease and gives an outlook on future developments."The principle of all things is water"Thales of Miletus (624 BC - 546 BC).

Myocardial microvascular permeability, interstitial oedema, and compromised cardiac function

The heart, perhaps more than any other organ, is exquisitely sensitive to increases in microvascular permeability and the accumulation of myocardial interstitial oedema fluid. Whereas some organs can cope with profound increases in the interstitial fluid volume or oedema formation without a compromise in function, heart function is significantly compromised with only a few percent increase in the interstitial fluid volume. This would be of little consequence if myocardial oedema were an uncommon pathology. On the contrary, myocardial oedema forms in response to many disease states as well as clinical interventions such as cardiopulmonary bypass and cardioplegic arrest common to many cardiothoracic surgical procedures. The heart's inability to function effectively in the presence of myocardial oedema is further confounded by the perplexing fact that the resolution of myocardial oedema does not restore normal cardiac function. We will attempt to provide some insight as to how microvascular permeability and myocardial oedema formation compromise cardiac function and discuss the acute changes that might take place in the myocardium to perpetuate compromised cardiac function following oedema resolution. We will also discuss compensatory changes in the interstitial matrix of the heart in response to chronic myocardial oedema and the role they play to optimize myocardial function during chronic oedemagenic disease.

High frequency ultrasound tissue characterization and acoustic microscopy of intracellular changes

The objective of this work is to investigate changes in the acoustic properties of cells when exposed to chemotherapy for monitoring treatment response. High frequency ultrasound spectroscopy (10-60 MHz) and scanning acoustic microscopy (0.9 GHz) were performed on HeLa cells (Ackermann et al. 1954, Masters 2002) that were exposed to the chemotherapeutic agent cisplatin. Ultrasonic radio-frequency data were acquired from pellets containing HeLa cells after exposure to cisplatin to induce apoptosis. Scanning acoustic and laser fluorescence microscopy images were recorded from single HeLa cells exposed to the same drug. Data acquisition in both cases was performed at several time points throughout the chemotherapeutic treatment for up to 27 h. In the high frequency ultrasound investigation, normalized power spectra were calculated within a region-of-interest. A 20 MHz transducer (f-number 2.35) and a 40 MHz transducer (f-number 3) were used for the data collection in the high frequency ultrasound experiments. The backscatter coefficients, integrated backscatter coefficients, mid-band fit and spectral slope were computed as a function of treatment time to monitor acoustical property changes during apoptosis. Acoustic attenuation was measured using the spectral substitution technique at all time points. Spectral parameter changes were detected after 12 h of exposure and coincided with the initiation of cell damage as assessed by optical microscopy. Integrated backscatter coefficients increased by over 100% between 0 h and 24 h of treatment, with small changes in the associated attenuation ( approximately 0.1 dB/[MHz cm]). Acoustic microscopy was performed at 0.9 GHz frequency. The cell structure was imaged using staining in laser fluorescence microscopy. All cells showed excellent correspondence between the locations of apoptotic nuclear condensation observed in optical imaging and changes in attenuation contrast in acoustic microscopy images. The time after drug exposure at which such changes occurred in the optical images were coincident with the time of changes detected in the acoustic microscopy images and the high frequency ultrasound experiments.

Ultrasonic radio-frequency spectrum analysis differentiates normal and edematous brain tissue from meningioma intraoperatively

Intraoperative ultrasound imaging of the brain is used for tumor localization and resection control. The aim of the present study was to prove whether spectral analysis of radio-frequency (rf) signals is able to improve its diagnostic capabilities by adding quantitative acoustical parameters to pure visual analysis. Meningioma was chosen as a first model because of its distinct borders during surgery as well as in ultrasound imaging. Rf signals were captured intraoperatively. Spectral analysis of rf signals was performed off-line in areas of normal brain, edematous tissue, and meningioma within the bandwidth of the transducer. At 5.0 MHz, attenuation allowed significant differentiation for normal brain versus edema (P= .00002), normal brain versus meningioma (P= .000004), and edema versus meningioma (P= .002). The slope of attenuation reached significant levels among the three groups, too. Backscatter analysis consisted of determination of the power spectral density with a significant difference for edema versus meningioma at 5 MHz (P= .02). The same was true for a relative integrated backscatter coefficient (P= .01). Frequency-dependent backscatter coefficients were estimated using a standard phantom with edema showing the highest values followed by parenchyma and meningioma. Spectral analysis of rf signals has the potential of differentiating intracranial tissues as could be shown exemplarily with meningioma in this study. If this is also true for infiltrating tumors, the method might serve as a tool to better define tumor borders, thus improving the extent of resection.

Quantitative ultrasonic tissue characterization as a new tool for continuous monitoring of chronic liver remodelling in mice

BACKGROUND/AIM

Recognition of the limitations of liver biopsies has led to the need for non-invasive tests to assess liver fibrosis from intensity and kinetic point of views. The aim of the present study was to evaluate non-invasive ultrasonic tissue characterization for the continuous monitoring of this process in mice.

METHODS

Twelve-week-old male and female C57Bl6/J mice were submitted to repetitive carbon-tetrachloride (CCl4) intraperitoneal injections during 8 weeks or analysed 28 days after common bile duct ligation (BDL). The extent and kinetic of the disease progression were followed by the measurement of ultrasound backscatter intensity. This was compared with histological and blood parameter analysis.

RESULTS

CCl4 induced a progressive increase in in vivo liver tissue backscatter intensity in both males and females. This increase was mainly correlated with interstitial fibrosis and, to a lower extent, with nuclear surface of the hepatocytes. A similar result was found after BDL.

CONCLUSIONS

These data demonstrate for the first time in a systematic study that ultrasound tissue characterization can be used as a reliable tool to follow liver remodelling in mice continuously.

Ultrasonic radio-frequency spectrum analysis of normal brain tissue

Acoustic tissue properties can be estimated using texture and/or spectral parameter analysis. Spectral analysis is based on the rf-signals whose frequency-content is commonly neglected in conventional B-mode imaging. Attenuation and backscatter values of normal brain tissue were analyzed. Unprocessed rf-data of 20 patients were sampled intraoperatively after craniotomy using a modified conventional ultrasonic device (Hitachi CS 9600) and analyzed off-line by a custom-made software routine. Before parameter estimation, influences of the diffraction pattern were compensated by means of a correction function obtained using a tissue-mimicking phantom. Attenuation of white matter showed a linear frequency dependence with a slope of 0.94 +/- 0.13 dB cm(-1) MHz(-1). The spectral slope was determined using 10 distinct frequencies between 2.5 and 5.75 MHz. Backscattering properties were analyzed by determining the power spectral density (PSD) and a relative backscatter coefficient (rel BSC) against the values derived from the tissue-mimicking phantom. PSD and rel BSC values were frequency-dependent, with highest PSD values at the probe's center frequency (-75.69 +/- 8.26 dB V(2) Hz(-1)). The corresponding rel BSC value at 5 MHz was determined as 15.39 +/- 8.26 dB. Finally, backscatter coefficients (BSC) of brain tissue were computed using the known BSC of the phantom. The data provided in this study are meant to serve as a base for intended future characterization of brain tissue that potentially allows intraoperative differentiation between normal and pathologic areas and therefore provides the surgeon with additional information for defining the extent of resection in brain more precisely.

Ultrasonic characterization of whole cells and isolated nuclei

High frequency ultrasound imaging (20 to 60 MHz) is increasingly being used in small animal imaging, molecular imaging and for the detection of structural changes during cell and tissue death. Ultrasonic tissue characterization techniques were used to measure the speed of sound, attenuation coefficient and integrated backscatter coefficient for (a) acute myeloid leukemia cells and corresponding isolated nuclei, (b) human epithelial kidney cells and corresponding isolated nuclei, (c) multinucleated human epithelial kidney cells and d) human breast cancer cells. The speed of sound for cells varied from 1522 to 1535 m/s, while values for nuclei were lower, ranging from 1493 to 1514 m/s. The attenuation coefficient slopes ranged from 0.0798 to 0.1073 dB mm(-1) MHz(-1) for cells and 0.0408 to 0.0530 dB mm(-1) MHz(-1) for nuclei. Integrated backscatter coefficient values for cells and isolated nuclei showed much greater variation and increased from 1.71 x 10(-4) Sr(-1) mm(-1) for the smallest nuclei to 26.47 x 10(-4) Sr(-1) mm(-1) for the cells with the largest nuclei. The findings suggest that integrated backscatter coefficient values, but not attenuation or speed of sound, are correlated with the size of the nuclei.

Evaluation of postmortem changes in tissue structure in the bottlenose dolphin (Tursiops truncatus)

Postmortem changes in geometry, density, and sound speed within organs and tissues (melon, bone, blubber, and mandibular fat) of the dolphin head were evaluated using computed tomography (CT) scans of live and postmortem bottlenose dolphins (Tursiops truncatus). Specimens were classified into three different treatment groups: live, recently dead, and frozen followed by thawing. Organs and tissues in similar anatomical regions of the head were compared in CT scans of the specimens to identify postmortem changes in morphology. In addition, comparisons of Hounsfield units in the CT scans were used to evaluate postmortem changes in the density of melon, bone, blubber, and mandibular fat. Sound speed measurements from melon, blubber, connective tissue, and muscle were collected from fresh and frozen samples in the same specimen to evaluate effects due to freezing and thawing process on sound speed measurements. Similar results in tissue and organ geometry, density, and sound speed measurements suggested that postmortem material is a reliable approximation for live melon, bone, blubber, muscle, connective tissue, and mandibular fat. These results have implications for examining viscoelastic properties and the accuracy of simulating sound transmission in postmortem material.

Towards an acoustic model-based poroelastic imaging method: II. experimental investigation

Soft biological tissue contains mobile fluid. The volume fraction of this fluid and the ease with which it may be displaced through the tissue could be of diagnostic significance and may also have consequences for the validity with which strain images can be interpreted according to the traditional idealizations of elastography. In a previous paper, under the assumption of frictionless boundary conditions, the spatio-temporal behavior of the strain field inside a compressed cylindrical poroelastic sample was predicted (Berry et al. 2006). In this current paper, experimental evidence is provided to confirm these predictions. Finite element modeling was first used to extend the previous predictions to allow for the existence of contact friction between the sample and the compressor plates. Elastographic techniques were then applied to image the time-evolution of the strain inside cylindrical samples of tofu (a suitable poroelastic material) during sustained unconfined compression. The observed experimental strain behavior was found to be consistent with the theoretical predictions. In particular, every sample studied confirmed that reduced values of radial strain advance with time from the curved cylindrical surface inwards towards the axis of symmetry. Furthermore, by fitting the predictions of an analytical model to a time sequence of strain images, parametric images of two quantities, each related to one or more of three poroelastic material constants were produced. The two parametric images depicted the Poisson's ratio (nu(s)) of the solid matrix and the product of the aggregate modulus (H(A)) of the solid matrix with the permeability (k) of the solid matrix to the pore fluid. The means of the pixel values in these images, nu(s) = 0.088 (standard deviation 0.023) and H(A)k = 1.449 (standard deviation 0.269) x 10(-7) m(2) s(-1), were in agreement with values derived from previously published data for tofu (Righetti et al. 2005). The results provide the first experimental detection of the fluid-flow-induced characteristic diffusion-like behavior of the strain in a compressed poroelastic material and allow parameters related to the above material constants to be determined. We conclude that it may eventually be possible to use strain data to detect and measure characteristics of diffusely distributed mobile fluid in tissue spaces that are too small to be imaged directly.

Cuvier's beaked whale (Ziphius cavirostris) head tissues: physical properties and CT imaging

Tissue physical properties from a Cuvier's beaked whale (Ziphius cavirostris) neonate head are reported and compared with computed tomography (CT) X-ray imaging. Physical properties measured include longitudinal sound velocity, density, elastic modulus and hysteresis. Tissues were classified by type as follows: mandibular acoustic fat, mandibular blubber, forehead acoustic fat (melon), forehead blubber, muscle and connective tissue. Results show that each class of tissues has unique, co-varying physical properties. The mandibular acoustic fats had minimal values for sound speed (1350+/-10.6 m s(-1)) and mass density (890+/-23 kg m(-3)). These values increased through mandibular blubber (1376+/-13 m s(-1), 919+/-13 kg m(-3)), melon (1382+/-23 m s(-1), 937+/-17 kg m(-3)), forehead blubber (1401+/-7.8 m s(-1), 935+/-25 kg m(-3)) and muscle (1517+/-46.8 m s(-1), 993+/-58 kg m(-3)). Connective tissue had the greatest mean sound speed and density (1628+/-48.7 m s(-1), 1087+/-41 kg m(-3)). The melon formed a low-density, low-sound-speed core, supporting its function as a sound focusing organ. Hounsfield unit (HU) values from CT X-ray imaging are correlated with density and sound speed values, allowing HU values to be used to predict these physical properties. Blubber and connective tissues have a higher elastic modulus than acoustic fats and melon, suggesting more collagen structure in blubber and connective tissues. Blubber tissue elastic modulus is nonlinear with varying stress, becoming more incompressible as stress is increased. These data provide important physical properties required to construct models of the sound generation and reception mechanisms in Ziphius cavirostris heads, as well as models of their interaction with anthropogenic sound.

Liver steatosis classification using high-frequency ultrasound

High-frequency B-mode images of 19 fresh human liver samples were obtained to evaluate their usefulness in determining the steatosis grade. The images were acquired by a mechanically controlled single-crystal probe at 25 MHz. Image features derived from gray-level concurrence and nonseparable wavelet transform were extracted to classify steatosis grade using a classifier known as the support vector machine. A subsequent histologic examination of each liver sample graded the steatosis from 0 to 3. The four grades were then combined into two, three and four classes. The classification results were correlated with histology. The best classification accuracies of the two, three and four classes were 90.5%, 85.8% and 82.6%, respectively, which were markedly better than those at 7 MHz. These results indicate that liver steatosis can be more accurately characterized using high-frequency B-mode ultrasound. Limitations and their potential solutions of applying high-frequency ultrasound to liver imaging are also discussed.