Similar Reproducibility for Strain and Shear Wave Elastography in Breast Mass Evaluation: A Prospective Study Using the Same Ultrasound System

The objective of this study was to evaluate the inter-operator reproducibility of strain elastography (SE) and shear wave elastography (SWE) in three groups: all lesions, benign lesions and malignant lesions. Ninety-one lesions from ninety-one women were examined by SE and SWE from January 2017 to December 2017 by two radiologists. The reproducibility of elastic score, SE strain ratio and SWE Young's modulus between operators was prospectively evaluated. There was good agreement on elasticity score, with κ values of 0.711, 0.640 and 0.766. The intra-class correlation coefficients of the strain ratio, mean elastic modulus (E_mean), maximum elastic modulus (E_max) and elastic modulus standard deviation (E_sd) ranged from 0.723-0.876, which indicated good and excellent agreement. We concluded that both SE and SWE had good reproducibility among different operators using the same probe in the same ultrasound instrument. Strain elasticity score was more consistent among operators in malignant breast tumors. There was better agreement on strain elastic ratio and shear wave elasticity among operators in benign breast lesions.

Estimation of Object Elasticity by Capturing Fingernail Images During Haptic Palpation

In this study, we present a system that performs natural-touch-based elasticity estimation for an object by using a depth camera. To estimate elasticity, which is defined as an object's Young's modulus, a strain-stress curve is obtained from fingernail images during haptic palpation. From a color image, the proposed system detects a fingernail and extracts 10 feature values related to the contact force; then, it estimates the force using a multiple regression model. Deformation of the object was estimated from the finger's three-dimensional position obtained from both color and depth images. Then, a strain-stress curve was determined using the force and deformation data. Evaluation experiments were designed to obtain the strain-stress curves of five objects from 10 participants; then, the estimation performance was investigated. The results show that the reliable range of sensing was within Young's modulus values of 0.12-5.6 MPa and the precision of the measurement was 55 percent of the estimated elasticity.

A dynamic ultrasound simulation of a pulsating three-layered CCA for validation of two-dimensional wall motion and blood velocity estimation algorithms

PURPOSE

A dynamic ultrasound simulation model for the common carotid artery (CCA) with three arterial layers for validation of two-dimensional wall motion and blood velocity estimation algorithms is proposed in the present study. This model describes layers with not only characteristics of echo distributions conforming to clinical ones but also varying thicknesses, axial, and radial displacements with pulsatile blood pressure during a cardiac cycle.

METHODS

The modeling process is as follows: first, a geometrical model according with the clinical structure size of a CCA is built based on the preset layer thicknesses and the diameter of lumen. Second, a three-dimensional scatterer model is constructed by a mapping with a Hilbert space-filling curve from the one-dimensional scatterer distribution with the position and amplitude following Gamma and Gaussian distributions, respectively. The characteristics of three layers and blood are depicted by smoothly adjusting the scatterer density, the scale, and shape parameters of the Gamma distribution as well as the mean and standard deviation of the Gaussian distribution. To obtain the values of parameters of scatterer distributions, including the shape parameter, density, and intensity, for arterial layers and blood, the envelope signals simulated from different configurations of scatterer distribution are compared with those from different kinds of tissue of CCAs in vivo through a statistic analysis. Finally, the dynamic scatterer model is realized based on the blood pressure, elasticity modulus of intima-media (IM) and adventitia, varying IM thickness, axial displacement of IM as well as blood flow velocity at central axis during a cardiac cycle. Then, the corresponding radiofrequency (RF) signals, envelope signals, and B-mode images of the pulsatile CCA are generated in a dynamic scanning mode using Field II platform.

RESULTS

The three arterial layers, blood, and surrounding tissue in simulated B-mode ultrasound images are clearly legible. The results based on a statistical analysis for the envelope signals from 30 simulations indicate that the echo characteristics of blood, intima, media, and adventitia are in accordant with clinical ones. The maximum relative errors between the preset geometrical sizes and the measured ones from the simulated images for the diameter of the lumen and the thicknesses of the intima, media, and adventitia are 0.13%, 3.89%, 1.35%, and 0.06%, respectively. For the dynamic parameters, the variation in IM thickness, the radial displacements of lumen and adventitia as well as the axial displacement of IM and blood flow velocity are measured with the mean relative errors of 68.03%, 9.27%, 2.10%, 4.93%, and 17.34%, respectively.

CONCLUSION

The simulated results present static sizes and dynamical variations according with preset values; echo distributions conforming to clinical versions. Therefore, the presented simulation model could be useful as a data source to evaluate the performance of studies on measurements of ultrasound-based tissue structures and dynamic parameters for the CCA layers.

Application of Elastography for the Noninvasive Assessment of Biomechanics in Engineered Biomaterials and Tissues

The elastic properties of engineered biomaterials and tissues impact their post-implantation repair potential and structural integrity, and are critical to help regulate cell fate and gene expression. The measurement of properties (e.g., stiffness or shear modulus) can be attained using elastography, which exploits noninvasive imaging modalities to provide functional information of a material indicative of the regeneration state. In this review, we outline the current leading elastography methodologies available to characterize the properties of biomaterials and tissues suitable for repair and mechanobiology research. We describe methods utilizing magnetic resonance, ultrasound, and optical coherent elastography, highlighting their potential for longitudinal monitoring of implanted materials in vivo, in addition to spatiotemporal limits of each method for probing changes in cell-laden constructs. Micro-elastography methods now allow acquisitions at length scales approaching 5-100 μm in two and three dimensions. Many of the methods introduced in this review are therefore capable of longitudinal monitoring in biomaterials and tissues approaching the cellular scale. However, critical factors such as anisotropy, heterogeneity and viscoelasity-inherent in many soft tissues-are often not fully described and therefore require further advancements and future developments.

A Modified Error in Constitutive Equation Approach for Frequency-Domain Viscoelasticity Imaging Using Interior Data

This paper presents a methodology for the inverse identification of linearly viscoelastic material parameters in the context of steady-state dynamics using interior data. The inverse problem of viscoelasticity imaging is solved by minimizing a modified error in constitutive equation (MECE) functional, subject to the conservation of linear momentum. The treatment is applicable to configurations where boundary conditions may be partially or completely underspecified. The MECE functional measures the discrepancy in the constitutive equations that connect kinematically admissible strains and dynamically admissible stresses, and also incorporates the measurement data in a quadratic penalty term. Regularization of the problem is achieved through a penalty parameter in combination with the discrepancy principle due to Morozov. Numerical results demonstrate the robust performance of the method in situations where the available measurement data is incomplete and corrupted by noise of varying levels.

Model-based reconstructive elasticity imaging using ultrasound

Elasticity imaging is a reconstructive imaging technique where tissue motion in response to mechanical excitation is measured using modern imaging systems, and the estimated displacements are then used to reconstruct the spatial distribution of Young's modulus. Here we present an ultrasound elasticity imaging method that utilizes the model-based technique for Young's modulus reconstruction. Based on the geometry of the imaged object, only one axial component of the strain tensor is used. The numerical implementation of the method is highly efficient because the reconstruction is based on an analytic solution of the forward elastic problem. The model-based approach is illustrated using two potential clinical applications: differentiation of liver hemangioma and staging of deep venous thrombosis. Overall, these studies demonstrate that model-based reconstructive elasticity imaging can be used in applications where the geometry of the object and the surrounding tissue is somewhat known and certain assumptions about the pathology can be made.

Solution of the nonlinear elasticity imaging inverse problem: The incompressible case

We have recently developed and tested an efficient algorithm for solving the nonlinear inverse elasticity problem for a compressible hyperelastic material. The data for this problem are the quasi-static deformation fields within the solid measured at two distinct overall strain levels. The main ingredients of our algorithm are a gradient based quasi-Newton minimization strategy, the use of adjoint equations and a novel strategy for continuation in the material parameters. In this paper we present several extensions to this algorithm. First, we extend it to incompressible media thereby extending its applicability to tissues which are nearly incompressible under slow deformation. We achieve this by solving the forward problem using a residual-based, stabilized, mixed finite element formulation which circumvents the Ladyzenskaya-Babuska-Brezzi condition. Second, we demonstrate how the recovery of the spatial distribution of the nonlinear parameter can be improved either by preconditioning the system of equations for the material parameters, or by splitting the problem into two distinct steps. Finally, we present a new strain energy density function with an exponential stress-strain behavior that yields a deviatoric stress tensor, thereby simplifying the interpretation of pressure when compared with other exponential functions. We test the overall approach by solving for the spatial distribution of material parameters from noisy, synthetic deformation fields.

Imaging the elastic properties of tissue: the 20 year perspective

After 20 years of innovation in techniques that specifically image the biomechanical properties of tissue, the evolution of elastographic imaging can be viewed from its infancy, through a proliferation of approaches to the problem to incorporation on research and then clinical imaging platforms. Ultimately this activity has culminated in clinical trials and improved care for patients. This remarkable progression represents a leading example of translational research that begins with fundamentals of science and engineering and progresses to needed improvements in diagnostic and monitoring capabilities applied to major categories of disease, surgery and interventional procedures. This review summarizes the fundamental principles, the timeline of developments in major categories of elastographic imaging, and concludes with recent results from clinical trials and forward-looking issues.

4-D x 3-D ultrasound: real-time scan conversion, filtering, and display of displacement vectors with a motorized curvilinear transducer

Recent research in the field of elastography has sought to expand displacement tracking to three dimensions. Once the 3-D volumes of displacement data have been obtained, they must be scan converted so that further processing, such as inversion methods to obtain tissue elasticity, can take place in Cartesian coordinates. This paper details an efficient and geometrically accurate algorithm to scan convert 3-D volumes of displacement vectors obtained from a motorized sector transducer. The proposed algorithm utilizes the physical scan geometry to convert the 3-D volumes of displacement data to both Cartesian coordinates and Cartesian displacements. Spatially varying filters are also proposed to prevent aliasing while minimizing data loss. Validation of the system has shown the algorithm to be correct to floating point precision, and the 3-D scan conversion and filtering can be performed faster than the native rate of data acquisition for the motorized transducer.

A high-frame-rate ultrasound system for the study of tissue motions

In this article, a technique for measuring fast periodic motion is proposed. The sequencing used in this technique is similar to the one used in conventional color Doppler systems. However, a phase correction algorithm is introduced which compensates for the acquisition delays. Criteria for the types of motion which could be detected correctly by the system are developed and presented. Effective frame rates of several hundred hertz to a few kilohertz have been achieved with the system. Applications of the system in tissue elastography are presented together with experimental results from tissue mimicking phantoms.

Theoretical limitations of the elastic wave equation inversion for tissue elastography

This article examines the theoretical limitations of the local inversion techniques for the measurement of the tissue elasticity. Most of these techniques are based on the estimation of the phase speed or the algebraic inversion of a one-dimensional wave equation. To analyze these techniques, the wave equation in an elastic continuum is revisited. It is proven that in an infinite medium, harmonic shear waves can travel at any phase speed greater than the classically known shear wave speed, mu/rho, by demonstrating this for a special case with cylindrical symmetry. Hence in addition to the mechanical properties of the tissue, the phase speed depends on the geometry of the wave as well. The elastic waves in an infinite cylindrical rod are studied. It is proven that multiple phase speeds can coexist for a harmonic wave at a single frequency. This shows that the phase speed depends not only on the mechanical properties of the tissue but also on its shape. The final conclusion is that the only way to avoid theoretical artifacts in the elastograms obtained by the local inversion techniques is to use the shear wave equation as expressed in the curl of the displacements, i.e., the rotations, for the inversion.

Measurement of viscoelastic properties of tissue-mimicking material using longitudinal wave excitation

This paper presents an experimental framework for the measurement of the viscoelastic properties of tissue-mimicking material. The novelty of the presented framework is in the use of longitudinal wave excitation and the study of the longitudinal wave patterns in finite media for the measurement of the viscoelastic properties. Ultrasound is used to track the longitudinal motions inside a test block. The viscoelastic parameters of the block are then estimated by 2 methods: a wavelength measurement method and a model fitting method. Connections are also made with shear elastography. The viscoelastic parameters are estimated for several homogeneous phantom blocks. The results from the new methods are compared with the conventional rheometry results.

Audio frequency in vivo optical coherence elastography

We present a new approach to optical coherence elastography (OCE), which probes the local elastic properties of tissue by using optical coherence tomography to measure the effect of an applied stimulus in the audio frequency range. We describe the approach, based on analysis of the Bessel frequency spectrum of the interferometric signal detected from scatterers undergoing periodic motion in response to an applied stimulus. We present quantitative results of sub-micron excitation at 820 Hz in a layered phantom and the first such measurements in human skin in vivo.

An optical coherence tomography (OCT)-based air jet indentation system for measuring the mechanical properties of soft tissues

A novel noncontact indentation system with the combination of an air jet and optical coherence tomography (OCT) was presented in this paper for the quantitative measurement of the mechanical properties of soft tissues. The key idea of this method is to use a pressure-controlled air jet as an indenter to compress the soft tissue in a noncontact way and utilize the OCT signals to extract the deformation induced. This indentation system provides measurement and mapping of tissue elasticity for small specimens with high scanning speed. Experiments were performed on 27 silicone tissue-mimicking phantoms with different Young's moduli, which were also measured by uniaxial compression tests. The regression coefficient of the indentation force to the indentation depth (N mm(-1)) was used as an indicator of the stiffness of tissue under air jet indentation. Results showed that the stiffness coefficients measured by the current system correlated well with the corresponding Young's moduli obtained by conventional mechanical testing (r = 0.89, p < 0.001). Preliminary in vivo tests also showed that the change of soft tissue stiffness with and without the contraction of the underlying muscles in the hand could be differentiated by the current measurement. This system may have broad applications in tissue assessment and characterization where alterations of mechanical properties are involved, in particular with the potential of noncontact micro-indentation for tissues.

Preliminary in vivo atherosclerotic carotid plaque characterization using the accumulated axial strain and relative lateral shift strain indices

In this paper, we explore two parameters or strain indices related to plaque deformation during the cardiac cycle, namely, the maximum accumulated axial strain in plaque and the relative lateral shifts between plaque and vessel wall under in vivo clinical ultrasound imaging conditions for possible identification of vulnerable plaque. These strain indices enable differentiation between calcified and lipidic plaque tissue utilizing a new perspective based on the stiffness and mobility of the plaque. In addition, they also provide the ability to distinguish between softer plaques that undergo large deformations during the cardiac cycle when compared to stiffer plaque tissue. Soft plaques that undergo large deformations over the cardiac cycle are more prone to rupture and to release micro-emboli into the cerebral bloodstream. The ability to identify vulnerable plaque, prone to rupture, would significantly enhance the clinical utility of this method for screening patients. We present preliminary in vivo results obtained from ultrasound radio frequency data collected over 16 atherosclerotic plaque patients before these patients undergo a carotid endarterectomy procedure. Our preliminary in vivo results indicate that the maximum accumulated axial strain over a cardiac cycle and the maximum relative lateral shift or displacement of the plaque are useful strain indices that provide differentiation between soft and calcified plaques.

Estimating elasticity in heterogeneous phantoms using Digital Image Elasto-Tomography

Results from the application of a Digital Image Elasto-Tomography (DIET) system to elasticity distribution estimation in heterogeneous phantoms are presented. Two simple phantoms comprising distinct hard and soft regions were created from silicone, with harmonic surface motion data captured using a steady-state stereo imaging setup. A two-parameter approach to estimating stiffness distribution was used, applying both corroborative and contradictive methods to the inverse problem. The contradictive approach proved more robust in the presence of error in a priori stiffness assumption. These contrast based methods have the ability to reduce the number of parameters required for shape-based stiffness reconstructions, and present a novel approach to inclusion imaging in elastography.

A novel image formation method for ultrasonic strain imaging

This paper presents a new method for forming high-quality ultrasonic strain images. To achieve this goal, three radiofrequency echo frames are selected by an automated performance assessment method and used to generate two parent strain images located in the same physical grid from which a high quality composite strain image may be calculated by averaging. The automatic performance evaluation method combines the consistency among the two parent strain images and the accuracy of motion tracking into a single summary "displacement quality measure." The proposed algorithm is evaluated with datasets acquired from in vivo breast tissue data. Our results show that that the proposed strain formation method shows substantial potential to outperform other methods available in the literature.

A novel method to obtain modulus image of soft tissues using water jet compression

Tissue stiffness is generally known to be associated with pathologic changes. Ultrasound indentation is able to assess the mechanical properties of soft tissues. Conventional ultrasound indentation devices use rigid flat-ended transducers to directly contact with the tissues and typically operate in the frequency ranging between 2 M Hz and 10 MHz. This paper introduced a novel ultrasound indentation system using water jet compression. The water jet served as an indenter as well as a medium for the propagation of the ultrasound beam. High frequency focused transducer was used to measure the indentation deformation at a microscopic level. It has been demonstrated that the system could effectively assess the tissue-mimicking phantoms with different stiffness. Moreover, another advantage of this novel indentation system was to apply C-scan on soft tissues rapidly and conveniently. By applying different pressures on C-scan sequences, the modulus image of the tissue could be obtained. This paper presented the preliminary results on gel phantoms. The spatial resolution and the sensitivity of the measurements, the reproducibility of the results were also discussed.

Coupling between elastic strain and interstitial fluid flow: ramifications for poroelastic imaging

We study the effects of interstitial fluid flow and interstitial fluid drainage on the spatio-temporal response of soft tissue strain. The motivation stems from the ability to measure in vivo strain distributions in soft tissue via elastography, and the desire to explore the possibility of using such techniques to investigate soft tissue fluid flow. Our study is based upon a mathematical model for soft tissue mechanics from the literature. It is a simple generalization of biphasic theory that includes coupling between the fluid and solid phases of the soft tissue, and crucially, fluid exchange between the interstitium and the local microvasculature. We solve the mathematical equations in two dimensions by the finite element method (FEM). The finite element implementation is validated against an exact analytical solution that is derived in the appendix. Realistic input tissue properties from the literature are used in conjunction with FEM modelling to conduct several computational experiments. The results of these lead to the following conclusions: (i) different hypothetical flow mechanisms lead to different patterns of strain relaxation with time; (ii) representative tissue properties show fluid drainage into the local microvasculature to be the dominant flow-related stress/strain relaxation mechanism; (iii) the relaxation time of strain in solid tumours due to drainage into the microvasculature is on the order of 5-10 s; (iv) under realistic applied pressure magnitudes, the magnitude of the strain relaxation can be as high as approximately 0.4% strain (4000 microstrains), which is well within the range of strains measurable by elastography.

A novel performance descriptor for ultrasonic strain imaging: a preliminary study

Ultrasonic strain imaging that uses signals from conventional diagnostic ultrasound systems is capable of showing the contrast of tissue elasticity, which provides new diagnostically valuable information. To assess and improve the diagnostic performance of ultrasonic strain imaging, it is essential to have a quantitative measure of image quality. Moreover, it is useful if the image quality measure is simple to interpret and can be used for visual feedback while scanning and as a training tool for operator performance evaluation. This report describes the development of a novel quantitative method for systematic performance assessment that is based on the combination of measures of the accuracy of motion tracking and consistency among consecutive strain fields. The accuracy of motion tracking assesses the reliability of strain images. The consistency among consecutive strain images assesses the signal quality in strain images. The clinical implications of the proposed method to differentiate good or poor strain images are discussed. Results of experiments with tissue-mimicking phantoms and in vivo breast-tissue data demonstrate that the performance measure is a useful method for automatically rating elasticity image quality.

Optical coherence elastography of engineered and developing tissue

Biomechanical elastic properties are among the many variables used to characterize in vivo and in vitro tissues. Since these properties depend largely on the micro- and macroscopic structural organization tissue, it is crucial to understand the mechanical properties and the alterations that occur tissues respond to external forces or to disease processes. Using a novel technique called coherence elastography (OCE), we mapped the spatially distributed mechanical displacements strains in a representative model of a developing, engineered tissue as cells began to proliferate attach within a three-dimensional collagen matrix. OCE was also performed in the complex tissue of the Xenopus laevis (African frog) tadpole. Displacements were quantified a cross-correlation algorithm on pre- and postcompression images, which were acquired using coherence tomography (OCT). The images of the engineered tissue were acquired over a 10-development period to observe the relative strain differences in various regions. OCE was able differentiate changes in strain over time, which corresponded with cell proliferation and matrix as confirmed with histological observations. By anatomically mapping the regional variation stiffness with micron resolution, it may be possible to provide new insight into the complex by which engineered and natural tissues develop complex structures.

Ultrasound elasticity imaging

Before the advent of diagnostic imaging, palpation was one of the main methods of clinical investigation for the evaluation of tumours. Malignant tumours feel harder that benign ones and this physical property is related to their coefficient of elasticity. Direct comparison of tissue images before and after application of a force is too crude a measure of elasticity except at extremes of differences in elasticity. Analysis of the raw imaging data, which contains very much more information than can be displayed for visual perception, can detect very much smaller differences in elasticity.

The radio frequency data of returning ultrasound echoes contain much more data than appears in an ultrasound image. Comparison, of the datasets of uncompressed tissue with compressed tissue, of a region of interest allows production of a strain (elasticity) image of that same region of interest. Change in tissue which is not visible on B-mode (greyscale) imaging can now be detected with real time strain imaging which is beginning to be developed on commercial ultrasound equipment. The information obtained with strain/elasticity imaging is now showing potential in influencing management of patients with breast problems.

Evaluation of an ultrasonic echo-tracking method for measurements of arterial wall movements in two dimensions

The longitudinal movement of blood vessel walls has so far gained little or no attention, as it has been presumed that these movements are of a negligible magnitude. However, modern high-resolution ultrasound scanners can demonstrate that the inner layers of the arterial wall exhibit considerable movements in the longitudinal direction. This paper evaluates a new, noninvasive, echo-tracking technique, which simultaneously can track both the radial and the longitudinal movements of the arterial wall with high resolution in vivo. Initially, the method is evaluated in vitro using a specially designed ultrasound phantom, which is attached to and moved by an X-Y system, the movement of which was compared with two high-resolution triangulation lasers. The results show an inaccuracy of 2.5% full scale deflection (fsd), reproducibility of 12 microm and a resolution of 5 microm, which should be more than sufficient for in vivo studies. The ability of the method is also demonstrated in a limited in vivo study in which a preselected part of the inner vessel wall of the right common carotid artery of a healthy volunteer is tracked in two dimensions over many cardiac cycles. The results show well reproducible x-y movement loops in which the recorded radial and longitudinal movements both are of the magnitude millimetre.

A modeling approach for burn scar assessment using natural features and elastic property

A modeling approach is presented for quantitative burn scar assessment. Emphases are given to: 1) constructing a finite-element model from natural image features with an adaptive mesh and 2) quantifying the Young's modulus of scars using the finite-element model and regularization method. A set of natural point features is extracted from the images of burn patients. A Delaunay triangle mesh is then generated that adapts to the point features. A three-dimensional finite-element model is built on top of the mesh with the aid of range images providing the depth information. The Young's modulus of scars is quantified with a simplified regularization functional, assuming that the knowledge of the scar's geometry is available. The consistency between the relative elasticity index and the physician's rating based on the Vancouver scale (a relative scale used to rate burn scars) indicates that the proposed modeling approach has high potential for image-based quantitative burn scar assessment.

Ultrasound elastography based on multiscale estimations of regularized displacement fields

Elasticity imaging is based on the measurements of local tissue deformation. The approach to ultrasound elasticity imaging presented in this paper relies on the estimation of dense displacement fields by a coarse-to-fine minimization of an energy function that combines constraints of conservation of echo amplitude and displacement field continuity. The multiscale optimization scheme presents several characteristics aimed at improving and accelerating the convergence of the minimization process. This includes the nonregularized initialization at the coarsest resolution and the use of adaptive configuration spaces. Parameters of the energy model and optimization were adjusted using data obtained from a tissue-like phantom material. Elasticity images from normal in vivo breast tissue were subsequently obtained with these parameters. Introducing a smoothness constraint into motion field estimation helped solve ambiguities due to incoherent motion, leading to elastograms less degraded by decorrelation noise than the ones obtained from correlation-based techniques.

A biomechanical model of the upper airways for simulating laryngoscopy

This paper describes a three-dimensional finite element model of the human upper airways during rigid laryngoscopy. In this procedure, an anaesthetist uses a rigid blade to displace and compress the tongue of the patient, and then inserts a tube into the larynx to allow controlled ventilation of the lungs during an operation. A realistic model of the main biomechanical aspects involved would help anaesthetists in training and in predicting difficult cases in advance. For this purpose, the finite element method was used to model structures such as the tongue, ligaments, larynx, vocal cords, bony landmarks, laryngoscope blade, and their inter-relationships, based on data extracted from X-ray, MRI, and photographic records. The model has been used to investigate how the tongue tissue behaves in response to the insertion of the laryngoscope blade, when it is subjected to a variety of loading conditions. In particular, the mechanical behaviour of the soft tissue of the tongue was simulated, from simple linear elastic material to complex non-linear viscoelastic material. The results show that, within a specific set of tongue material parameters, the simulated outcome can be successfully related to the view of the vocal cords achieved during real laryngoscopies on normal subjects, and on artificially induced difficult laryngoscopy, created by extending the upper incisors teeth experimentally.

Intraluminal ultrasonic palpation: assessment of local and cross-sectional tissue stiffness

Many intravascular therapeutic techniques for the treatment of significant atherosclerotic lesions are mechanical in nature: examples are angioplasty, stenting and atherectomy. The selection of the most adequate treatment would be advantageously aided by knowledge of the mechanical properties of the lesion and surrounding tissues. Based on the success of intravascular ultrasound (IVUS) in accurately depicting the morphology of atheromatous lesions, ultrasonic tissue characterisation has been proposed as a tool to determine the composition of atheroma. We describe the addition of local compliance information to the IVUS image in the form of a colour-coded line congruent with the lumen perimeter. The technique involves analysis of echo signals obtained at two or more states of incremental intravascular pressure. Using vessel phantoms and specimens, we demonstrate the utility of intravascular compliance imaging. The palpograms are able to identify lesions of different elasticity independently of the echogenicity contrast, because the information provided by the elastograms is generally independent of that obtained from the IVUS image. Thus, the palpogram can complement the characterisation of lesion from the IVUS image. We also describe cross-sectional measures of elasticity that are based on the elastogram. Finally, natural extensions of intravascular palpation to other endoluminal ultrasound applications are proposed.

Estimation of the correlation amplitude of RF signals in small cutaneous vessels

Time domain correlation technique is a widely used method for blood flow velocity measurement. The time shift between a pair of windowed ultrasonic echoes is estimated by searching the temporal position of the maximum of the interpolated normalized correlation function. Between two consecutive echoes, the acoustical footprint of a group of scatterers, which are transported with the flow, moves and is deformed. This implies a decreasing of the amplitude of the normalized correlation coefficient. In the case of microcirculation (low flow rate, low SNR), the amplitude of the correlation peak can be used to detect the presence of blood flow and to discriminate false and true detections (reliability index). We have numerically evaluated the statistical performances of the cross-correlation algorithm used as a correlation peak amplitude estimator in severe conditions (short correlation window length, low SNR). These theoretical results have been compared with in vitro experimentation on a 100-/spl mu/m-diameter microcirculatory phantom and with in vivo experimentation on a 180-/spl mu/m-diameter vessel of a human leg carrying erysipelas.

An overlapping subzone technique for MR-based elastic property reconstruction

A finite element-based nonlinear inversion scheme for magnetic resonance (MR) elastography is detailed. The algorithm operates on small overlapping subzones of the total region of interest, processed in a hierarchical order as determined by progressive error minimization. This zoned approach allows for a high degree of spatial discretization, taking advantage of the data-rich environment afforded by the MR. The inversion technique is tested in simulation under high-noise conditions (15% random noise applied to the displacement data) with both complicated user-defined stiffness distributions and realistic tissue geometries obtained by thresholding MR image slices. In both cases the process has proved successful and has been capable of discerning small inclusions near 4 mm in diameter. Magn Reson Med 42:779-786, 1999.

Echo decorrelation from displacement gradients in elasticity and velocity estimation

Several ultrasonic techniques for the estimation of blood velocity, tissue motion and elasticity are based on the estimation of displacement through echo time-delay analysis. A common assumption is that tissue displacement is constant within a short observation time used for time delay estimation (TDE). The precision of TDE is mainly limited by noise sources corrupting the echo signals. In addition to electronic and quantization noise, a substantial source of TDE error is the decorrelation of echo signals because of displacement gradients within the observation time. The authors present a theoretical model that describes the mean changes of the crosscorrelation function as a function of observation time and displacement gradient. The gradient is assumed to be small and uniform within the observation time; the decorrelation introduced by the lateral and elevational displacement components is assumed to be small compared with the decorrelation caused by the axial component. The decorrelation model predicts that the expected value of the crosscorrelation function is a low-pass filtered version of the autocorrelation function (i.e., the crosscorrelation obtained without gradients). The filter is a function of the axial gradient and the observation time. This theoretical finding is corroborated experimentally. Limitations imposed by decorrelation in displacement estimation and potential uses of decorrelation in medical ultrasound are discussed.

Elastic moduli of breast and prostate tissues under compression

To evaluate the dynamic range of tissue imaged by elastography, the mechanical behavior of breast and prostate tissue samples subject to compression loading has been investigated. A model for the loading was validated and used to guide the experimental design for data collection. The model allowed the use of small samples that could be considered homogeneous; this assumption was confirmed by histological analysis. The samples were tested at three strain rates to evaluate the viscoelastic nature of the material and determine the validity of modeling the tissue as an elastic material for the strain rates of interest. For loading frequencies above 1 Hz, the storage modulus accounted for over 93 percent of the complex modulus. The data show that breast fat tissue has a constant modulus over the strain range tested while the other tissues have a modulus that is dependent on the strain level. The fibrous tissue samples from the breast were found to be 1 to 2 orders of magnitude stiffer than fat tissue. Normal glandular breast tissue was found to have an elastic modulus similar to that of fat at low strain levels, but the modulus of the glandular tissue increased by an order of magnitude above fat at high strain levels. Carcinomas from the breast were stiffer than the other tissues at the higher strain level; intraductal in situ carcinomas were like fat at the low strain level and much stiffer than glandular tissue at the high strain level. Infiltrating ductal carcinomas were much stiffer than any of the other breast tissues. Normal prostate tissue has a modulus that is lower than the modulus of the prostate cancers tested. Tissue from prostate with benign prostatic hyperplasia (BPH) had modulus values significantly lower than normal tissue. There was a constant but not significant difference in the modulus of tissues taken from the anterior and posterior portions of the gland.

OCT elastography: imaging microscopic deformation and strain of tissue

Optical coherence tomography (OCT) has been applied to the study of the microscopic deformation of biological tissue under compressive stress. We describe the hardware and theory of operation of an OCT elastography system that measures internal displacements as small as a few micrometers by using 2D cross-correlation speckle tracking. Results obtained from gelatin scattering models, pork meat, and intact skin suggest possible medical applications of the technique.

The nonstationary strain filter in elastography: Part II. Lateral and elevational decorrelation

The nonstationary evolution of the strain filter due to lateral and elevational motion of the tissue scatterers across the ultrasound beam is analyzed for the 1-D cross-correlation-based strain estimator. The effective correlation coefficient that includes the contributions due to lateral and elevational signal decorrelation is used to derate the upper bound of the signal-to-noise ratio in the elastogram (SNRe) predicted by the ideal strain filter. In the case of an elastically homogeneous target, if the transducer is on the axis of symmetry of such target in the elevational direction, the motion of the scatterers out the imaging plane is minimized. In addition, the ultrasound beam along the elevational direction is broader, allowing scatterers to stay longer within the beam during tissue compression. Under these conditions, lateral signal decorrelation becomes the primary contributor to the nonstationary behavior of the strain filter. Both the elastographic SNRe and the dynamic range are reduced, with an increase in lateral decorrelation. Finite element simulations and phantom experiments are presented in this paper to corroborate the theoretical strain filter. The nonstationary behavior of the strain filter is reduced by confining the tissue in the lateral direction (minimizing motion of tissue scatterers), thereby improving the quality of the elastogram.