Tissue harmonic image analysis based on spatial covariance

A review on B/A measurement methods with a clinical perspective

The nonlinear parameter of ultrasound B/A has shown to be a useful diagnostic parameter, reflecting medium content, structure, and temperature. Despite its recognized values, B/A is not yet used as a diagnostic tool in the clinic due to the limitations of current measurement and imaging techniques. This review presents an extensive and comprehensive overview of the techniques developed for B/A measurement of liquid and liquid-like media (e.g., tissue), identifying the methods that are most promising from a clinical perspective. This work summarizes the progress made in the field and the typical challenges on the way to B/A estimation. Limitations and problems with the current techniques are identified, suggesting directions that may lead to further improvement. Since the basic theory of the physics behind the measurement strategies is presented, it is also suited for a reader who is new to nonlinear ultrasound.

Harmonic imaging with fresnel beamforming in the presence of phase aberration

Fresnel beamforming is a beamforming method with a delay profile similar in shape to a physical Fresnel lens. The advantage of Fresnel beamforming is the reduced channel count, which consists of four to eight transmit and two analog-to-digital receive channels. Fresnel beamforming was found to perform comparably to conventional delay-and-sum beamforming. However, the performance of Fresnel beamforming is highly dependent on focal errors. These focal errors result in high side-lobe levels and further reduce the performance of Fresnel beamforming in the presence of phase aberration. With the advantages of lower side-lobe levels and suppression of aberration effects, harmonic imaging offers an effective solution to the limitations of Fresnel beamforming. We describe the implementation of tissue harmonic imaging and pulse inversion harmonic imaging in Fresnel beamforming, followed by dual apodization with cross-correlation, to improve image quality. Compared with conventional delay-and-sum beamforming, experimental results indicated contrast-to-noise ratio improvements of 10%, 49% and 264% for Fresnel beamforming using tissue harmonic imaging in the cases of no aberrator, 5-mm pork aberrator and 12-mm pork aberrator, respectively. These improvements were 22%, 57% and 352% for Fresnel beamforming using pulse inversion harmonic imaging. Moreover, dual apodization with cross-correlation was found to further improve the contrast-to-noise ratios in all cases. Harmonic imaging was also found to narrow the lateral beamwidth and shorten the axial pulse length by at least 25% and 21%, respectively, for Fresnel beamforming at different aberration levels. These results suggest the effectiveness of harmonic imaging in improving image quality for Fresnel beamforming, especially in the presence of phase aberration. Even though this combination of Fresnel beamforming and harmonic imaging does not outperform delay-and-sum beamforming combined with harmonic imaging, it provides the benefits of reduced channel count and potentially reduced cost and size of ultrasound systems.

Umbilical venous blood flow and its measurement in the human fetus

In this review, we evaluate the published methodologies to describe a noninvasive technique for the quantitative assessment of umbilical venous blood flow in the human fetus. We identify a number of variations in the reported methodologies and address some of the common errors associated with Doppler assessment of umbilical venous flow volume. The potential role of umbilical venous flow volumetry in the management of intrauterine growth restriction is briefly evaluated including its utility and reliability in everyday clinical practice.

Broadband reduction of the second harmonic distortion during nonlinear ultrasound wave propagation

Ultrasound contrast harmonic imaging and detection techniques are hampered by the harmonic distortion of the ultrasound wave caused by the nonlinearities of the medium. To increase the discrimination between the tissue and ultrasound contrast agents at higher harmonics, we investigate a tissue harmonic suppression technique. The main attention of the research is the signal that is introduced at the source and is constructed out of several discrete frequency components from the second harmonic band. Therefore, this method was coined as the multiple component second harmonic reduction signal or multiple component SHRS. By adjusting the amplitude and phase of discrete components and simultaneously propagating multiple component SHRS with the imaging signal, the nonlinear distortion of the ultrasound waveform is considerably reduced. Using the numerical simulation, the optimal parameters for multiple component SRHS were deduced. The simulations results were corroborated in the water tank experiments and showed 40 dB reduction with respect to the fundamental, covering up to 75% of the entire second harmonic band. In the other series of experiments with the clinically used contrast agent, the uniform increase in agent-to-tissue ratio of 7.4 dB over a relatively large region of imaging was observed. The use of the proposed method in the everyday clinical practice can improve discrimination between the tissue and the contrast agent in harmonic imaging.

Impact of tissue harmonic imaging on measurement of nuchal translucency thickness

OBJECTIVES

To evaluate the effect of tissue harmonic imaging (THI) on the measurement of fetal nuchal translucency thickness (NT).

METHODS

One-hundred and three pregnant women underwent first-trimester NT measurement according to The Fetal Medicine Foundation criteria. NT was evaluated using conventional ultrasonography (CUS) and THI without modifying any other ultrasound parameter (e.g. gain). For each patient three images with CUS and three images with THI were stored and then measured independently on the ultrasound system by two different operators. The maximum measurements using CUS and THI were compared. Differences between the values of CUS and THI NT measurements were tested using the Wilcoxon signed-rank test. Bland-Altman plots were constructed, and intraobserver and interobserver variabilities were assessed by calculation of the intraclass correlation coefficient. Probability values of < 0.05 were considered significant.

RESULTS

Mean maternal age was 32.8 (range, 20-42) years, mean gestational age at examination was 12 + 1 (11 + 0 to 13 + 6) weeks and mean crown-rump length (CRL) was 55.8 (SD, 7.2) mm. Median fetal NT was 1.4 (0.8-3.5) mm using CUS and 1.2 (0.6-3.3) mm using THI (P < 0.001) for the first operator. A second operator remeasured the first 51 cases: median fetal NT was 1.4 (0.8-3.8) mm using CUS and 1.1 (0.6-3.1) mm using THI (P < 0.001). Fetal NT measurements were above the expected median value according to CRL in 49 cases (47.6%) using CUS and in only 24 cases (23.3%) using THI.

CONCLUSIONS

THI leads to a small, but significant, reduction of the NT measurement and this could reduce the sensitivity of screening for Down syndrome.

Elastography using harmonic ultrasonic imaging: a feasibility study

Tissue Harmonic Imaging (THI) is a relatively new modality that has had a significant impact in the ultrasound field. In the recent past, imaging the mechanical properties of tissues using elastography has also gained great interest. In this paper, we investigate the feasibility of combining these two state-of-the-art ultrasound-imaging modalities. The performance of elastograms obtained using harmonic ultrasonic signals is studied with simulations and compared to the performance of conventional elastograms using standard statistical methods. Experiments are used as a proof of the technical feasibility of generating tissue-harmonic elastograms using experimental harmonic signals. The results of our simulation study indicate that all image quality factors considered in this study (elastographic signal-to-noise ratio, elastographic contrast-to-noise ratio and spatial resolution) may be improved when using harmonic ultrasonic signals, provided that the ultrasound system is characterized by high bandwidth, high sampling frequency and large lateral sampling. Preliminary experimental results suggest that it is technically feasible to generate experimental elastograms using harmonic signals, provided that the sonographic signal-to-noise ratio of the pre- and postcompression harmonic frames is sufficiently high to guarantee reliable values of correlation.

Spatial coherence of the nonlinearly generated second harmonic portion of backscatter for a clinical imaging system

Correlation-based approaches to phase aberration correction rely on the spatial coherence of backscattered signals. The spatial coherence of backscatter from speckle-producing targets is predicted by the auto correlation of the transmit apodization (Van Cittert-Zernike theorem). Work by others indicates that the second harmonic beam has a wider mainlobe with lower sidelobes than a beam transmitted at 2f. The purpose of this paper is to demonstrate that the spatial coherence of backscatter for the second harmonic is different from that of the fundamental, as would be anticipated from applying the Van Cittert-Zernike theorem to the reported measurements of the second harmonic field. Another objective of this work is to introduce the concept of the effective apodization and to verify that the effective apodization of the second harmonic is narrower than the transmit apodization. The spatial coherence of backscatter was measured using three clinical arrays with a modified clinical imaging system. The spatial coherence results were verified using a pseudo-array scan in a transverse plane of the transmitted field with a hydrophone. An effective apodization was determined by backpropagating these values using a linear angular spectrum approach. The spatial coherence for the harmonic portion of backscatter differed systematically and significantly from the auto correlation of the transmit apodization.

Spatial coherence analysis applied to aberration correction using a two-dimensional array system

Complex degree of coherence functions are computed using synthetic and measured ultrasound data to demonstrate noteworthy aspects of coherence analysis in the context of aberration correction. Coherence functions calculated from synthetic data illustrate the importance of proper normalization of the constituent cross-correlation integrals when weak elements and receiver directivity are significant factors. The synthetic data also show that a spike can occur at the zero-lag position of the coherence function when the signal-to-noise ratio is reduced by element directivity near the edges of a large aperture. The latter observation is confirmed by experimental data acquired through tissue-mimicking distributed aberration phantoms using a low f-number two-dimensional array system. The coherence of data acquired at neighboring elements is not changed by time-shift compensation of transmit and receive focusing, but time-shift compensation does improve the coherence of echoes measured over larger separations. The resulting increase in coherence widths evaluated at levels between 0.2 and 0.5 is correlated with narrower -10 dB and -20 dB effective widths in focuses visualized using single-transmit images. Iterative focus compensation methods may benefit from aberration estimation algorithms that take advantage of these longer-range correlations in random-scattering waveforms.