Magnetic resonance elastography using 3D gradient echo measurements of steady-state motion

Continuous Shear Wave Elastography for Liver Using Frame-to-Frame Equalization of Complex Amplitude

This study addresses a crucial necessity in the field of noninvasive liver fibrosis diagnosis by introducing the concept of continuous shear wave elastography (C-SWE), utilizing an external vibration source and color Doppler imaging. However, an application of C-SWE to assess liver elasticity, a deep region within the human body, arises an issue of signal instability in the obtained data. To tackle this challenge, this work proposes a method involving the acquisition of multiple frames of datasets, which are subsequently compressed. Furthermore, the proposed frame-to-frame equalization method compensates discrepancies in the initial phase that might exist among multiple-frame datasets, thereby significantly enhancing signal stability. The experimental validation of this approach encompasses both phantom tests and in vivo experiments. In the phantom tests, the proposed technique is validated through a comparison with the established shear wave elastography (SWE) technique. The results demonstrate a remarkable agreement, with an error in shear wave velocity of less than 4.2%. Additionally, the efficacy of the proposed method is confirmed through in vivo tests. As a result, the stabilization of observed shear waves using the frame-to-frame equalization technique exhibits promising potential for accurately assessing human liver elasticity. These findings collectively underscore the viability of C-SWE as a potential diagnostic instrument for liver fibrosis.

Reverberant magnetic resonance elastographic imaging using a single mechanical driver

Reverberant elastography provides fast and robust estimates of shear modulus; however, its reliance on multiple mechanical drivers hampers clinical utility. In this work, we hypothesize that for constrained organs such as the brain, reverberant elastography can produce accurate magnetic resonance elastograms with a single mechanical driver. To corroborate this hypothesis, we performed studies on healthy volunteers (n= 3); and a constrained calibrated brain phantom containing spherical inclusions with diameters ranging from 4-18 mm. In both studies (i.e. phantom and clinical), imaging was performed at frequencies of 50 and 70 Hz. We used the accuracy and contrast-to-noise ratio performance metrics to evaluate reverberant elastograms relative to those computed using the established subzone inversion method. Errors incurred in reverberant elastograms varied from 1.3% to 16.6% when imaging at 50 Hz and 3.1% and 16.8% when imaging at 70 Hz. In contrast, errors incurred in subzone elastograms ranged from 1.9% to 13% at 50 Hz and 3.6% to 14.9% at 70 Hz. The contrast-to-noise ratio of reverberant elastograms ranged from 63.1 to 73 dB compared to 65 to 66.2 dB for subzone elastograms. The average global brain shear modulus estimated from reverberant and subzone elastograms was 2.36 ± 0.07 kPa and 2.38 ± 0.11 kPa, respectively, when imaging at 50 Hz and 2.70 ± 0.20 kPa and 2.89 ± 0.60 kPa respectively, when imaging at 70 Hz. The results of this investigation demonstrate that reverberant elastography can produce accurate, high-quality elastograms of the brain with a single mechanical driver.

Reverberant shear wave phase gradients for elastography

Reverberant shear wave fields are produced when multiple sources and multiple reflections establish a complex three-dimensional wave field within an organ. The expected values are assumed to be isotropic across all directions and the autocorrelation functions for velocity are expressed in terms of spherical Bessel functions. These results provide the basis for adroit implementations of elastography from imaging systems that can map out the internal velocity or displacement of tissues during reverberant field excitations. By examining the phase distribution of the reverberant field, additional estimators can be derived. In particular, we demonstrate that the reverberantphase gradientis shown to be proportional to the local value of wavenumber. This phase estimator is less sensitive to imperfections in the reverberant field distribution and requires a smaller support window, relative to earlier estimators based on autocorrelation. Applications are shown in simulations, phantoms, andin vivoliver.

Breast Tumor Diagnosis Using Finite-Element Modeling Based on Clinical in vivo Elastographic Data

OBJECTIVES

This study exploited finite-element modeling (FEM) to simulate breast tissue multicompression during ultrasound elastography to classify breast tumors based on their nonlinear biomechanical properties.

METHODS

Numeric simulations were first calculated by using 3-dimensional (3D) virtual models with an assumed tumor's geometric dimensions but with actual material properties to test and validate the FEM. Further numeric simulations were used to construct 3D models based on in vivo experimental data to verify our models. The models were designed for each individual in vivo case, emphasizing the geometry, position, and biomechanical properties of the breast tissue. At different compression levels, tissue strains were analyzed between the tumors and the background normal tissues to explore their nonlinearity and classify the tumor type. Tumor classification parameters were deduced by using a power-law relationship between the applied compressive forces and strain differences.

RESULTS

Classification parameters were compared between benign and malignant tumors, for which they were found to be statistically significant in classifying the tumor types (P < .05) by both the validation and verification of FEM. We compared the classification parameters between the in vivo and FEM classifications, for which they were found to be strongly correlated (R = 0.875; P < .001), with no statistical differences between their outcomes (P = .909).

CONCLUSIONS

Good agreement between the model outcomes and the in vivo diagnostics was reported. The implemented models were validated and verified. The introduced 3D modeling method may augment elastographic methods to preliminary classify breast tumors at an early stage.

MR Elastography of the Breast: Evolution of Technique, Case Examples, and Future Directions

Recognizing that breast cancers present as firm, stiff lesions, the foundation of breast magnetic resonance elastography (MRE) is to combine tissue stiffness parameters with sensitive breast MR contrast-enhanced imaging. Breast MRE is a non-ionizing, cross-sectional MR imaging technique that provides for quantitative viscoelastic properties, including tissue stiffness, elasticity, and viscosity, of breast tissues. Currently, the technique continues to evolve as research surrounding the use of MRE in breast tissue is still developing. In the setting of a newly diagnosed cancer, associated desmoplasia, stiffening of the surrounding stroma, and necrosis are known to be prognostic factors that can add diagnostic information to patient treatment algorithms. In fact, mechanical properties of the tissue might also influence breast cancer risk. For these reasons, exploration of breast MRE has great clinical value. In this review, we will: (1) address the evolution of the various MRE techniques; (2) provide a brief overview of the current clinical studies in breast MRE with interspersed case examples; and (3) suggest directions for future research.

Unipolar MR elastography: Theory, numerical analysis and implementation

In MR elastography (MRE), zeroth moment balanced motion-encoding gradients (MEGs) are incorporated into MRI sequences to induce a phase shift proportional to the local displacement caused by external actuation. To maximize the signal-to-noise ratio (SNR), fractional encoding is employed, i.e., the MEG duration is reduced below the wave period. Here, gradients encode primarily the velocity of the motion-reducing encoding efficiency. Thus, in GRE-MRE, T₂ * decay and motion sensitivity have to be balanced, imposing a lower limit on repetition times (TRs). We propose to use a single trapezoidal gradient, a "unipolar gradient", to directly encode spin displacement. Such gradients cannot be used in conventional sequences as they exhibit a large zeroth moment and dephase magnetization. By time-reversing a spoiled SSFP sequence, the spoiling gradient becomes an efficient unipolar MEG. The proposed "unipolar MRE" technique benefits from this approach in three ways: first, displacement encoding is split over multiple TRs increasing motion sensitivity; second, spoiler and MEG coincide, allowing a reduction in TR; third, motion sensitivity of a typical unipolar lobe is of an order of magnitude higher than a bipolar MEG of equal duration. In this work, motion encoding using unipolar MRE is analyzed using the extended phase graph (EPG) formalism with a periodic motion propagator. As an approximation, the two-transverse TR approximation for diffusion-weighted SSFP is extended to incorporate cyclic motion. A complex encoding efficiency metric is introduced to compare the displacement fields of unipolar and conventional GRE-MRE sequences in both magnitude and phase. The derived theoretical encoding equations are used to characterize the proposed sequence using an extensive parameter study. Unipolar MRE is validated against conventional GRE-MRE in a phantom study showing excellent agreement between measured displacement fields. In addition, unipolar MRE yields significantly increased octahedral shear strain-SNR relative to conventional GRE-MRE and allows for the recovery of high stiffness inclusions, where conventional GRE-MRE fails.

Encoding and readout strategies in magnetic resonance elastography

Magnetic resonance elastography (MRE) has evolved significantly since its inception. Advances in motion-encoding gradient design and readout strategies have led to improved encoding and signal-to-noise ratio (SNR) efficiencies, which in turn allow for higher spatial resolution, increased coverage, and/or shorter scan times. The purpose of this review is to summarize MRE wave-encoding and readout approaches in a unified mathematical framework to allow for a comparative assessment of encoding and SNR efficiency of the various methods available. Besides standard full- and fractional-wave-encoding approaches, advanced techniques including flow compensation, sample interval modulation and multi-shot encoding are considered. Signal readout using fast k-space trajectories, reduced field of view, multi-slice, and undersampling techniques are summarized and put into perspective. The review is concluded with a foray into displacement and diffusion encoding as alternative and/or complementary techniques.

Quantitative Elastography Methods in Liver Disease: Current Evidence and Future Directions

Chronic liver diseases often result in the development of liver fibrosis and ultimately, cirrhosis. Treatment strategies and prognosis differ greatly depending on the severity of liver fibrosis, thus liver fibrosis staging is clinically relevant. Traditionally, liver biopsy has been the method of choice for fibrosis evaluation. Because of liver biopsy limitations, noninvasive methods have become a key research interest in the field. Elastography enables the noninvasive measurement of tissue mechanical properties through observation of shear-wave propagation in the tissue of interest. Increasing fibrosis stage is associated with increased liver stiffness, providing a discriminatory feature that can be exploited by elastographic methods. Ultrasonographic (US) and magnetic resonance (MR) imaging elastographic methods are commercially available, each with their respective strengths and limitations. Here, the authors review the technical basis, acquisition techniques, and results and limitations of US- and MR-based elastography techniques. Diagnostic performance in the most common etiologies of chronic liver disease will be presented. Reliability, reproducibility, failure rate, and emerging advances will be discussed. ^© RSNA, 2018 Online supplemental material is available for this article.

Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers

PURPOSE

To evaluate the repeatability and reproducibility of 2D and 3D hepatic MRE with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers.

MATERIALS AND METHODS

Nine healthy volunteers underwent two same-day MRE exams separated by a 5- to 10-min break. In each exam, 2D and 3D MRE scans were performed, each under four conditions (2 driver types [rigid, flexible] × 2 breath-hold phases [end-expiration, end-inspiration]). Repeatability (measurements under identical conditions) and reproducibility (measurements under different conditions) were analyzed by calculating bias, limit of agreement, repeatability coefficient (RC), reproducibility coefficient (RDC), intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC), as appropriate.

RESULTS

For 2D MRE, RCs and ICCs range between 0.29-0.49 and 0.71-0.91, respectively. For 3D MRE, RCs and ICCs range between 0.16-0.26 and 0.84-0.96, respectively. Stiffness values were biased by breath-hold phase, being higher at end-inspiration than end-expiration, and the differences were significant for 3D MRE (p < 0.01). No bias was found between driver types. Inspiration vs. expiration RDCs and CCCs ranged between 0.30-0.54 and 0.61-0.72, respectively. Rigid vs. flexible driver RDCs and CCCs ranged between 0.10-0.44 and 0.79-0.94, respectively.

CONCLUSION

This preliminary study suggests that 2D MRE and 3D MRE under most conditions potentially have good repeatability. Our result also points to the possibility that stiffness measured with the rigid and flexible drivers is reproducible. Reproducibility between breath-hold phases was modest, suggesting breath-hold phase might be a confounding factor in MRE-based stiffness measurement. However, larger studies are required to validate these preliminary results.

Gradient-Based Optimization for Poroelastic and Viscoelastic MR Elastography

We describe an efficient gradient computation for solving inverse problems arising in magnetic resonance elastography (MRE). The algorithm can be considered as a generalized 'adjoint method' based on a Lagrangian formulation. One requirement for the classic adjoint method is assurance of the self-adjoint property of the stiffness matrix in the elasticity problem. In this paper, we show this property is no longer a necessary condition in our algorithm, but the computational performance can be as efficient as the classic method, which involves only two forward solutions and is independent of the number of parameters to be estimated. The algorithm is developed and implemented in material property reconstructions using poroelastic and viscoelastic modeling. Various gradient- and Hessian-based optimization techniques have been tested on simulation, phantom and in vivo brain data. The numerical results show the feasibility and the efficiency of the proposed scheme for gradient calculation.

Overhauser-enhanced magnetic resonance elastography

Magnetic resonance elastography (MRE) is a powerful technique to assess the mechanical properties of living tissue. However, it suffers from reduced sensitivity in regions with short T2 and T2 * such as in tissue with high concentrations of paramagnetic iron, or in regions surrounding implanted devices. In this work, we exploit the longer T2 * attainable at ultra-low magnetic fields in combination with Overhauser dynamic nuclear polarization (DNP) to enable rapid MRE at 0.0065 T. A 3D balanced steady-state free precession based MRE sequence with undersampling and fractional encoding was implemented on a 0.0065 T MRI scanner. A custom-built RF coil for DNP and a programmable vibration system for elastography were developed. Displacement fields and stiffness maps were reconstructed from data recorded in a polyvinyl alcohol gel phantom loaded with stable nitroxide radicals. A DNP enhancement of 25 was achieved during the MRE sequence, allowing the acquisition of 3D Overhauser-enhanced MRE (OMRE) images with (1.5 × 2.7 × 9) mm(3) resolution over eight temporal steps and 11 slices in 6 minutes. In conclusion, OMRE at ultra-low magnetic field can be used to detect mechanical waves over short acquisition times. This new modality shows promise to broaden the scope of conventional MRE applications, and may extend the utility of low-cost, portable MRI systems to detect elasticity changes in patients with implanted devices or iron overload.

Contactless remote induction of shear waves in soft tissues using a transcranial magnetic stimulation device

This study presents the first observation of shear waves induced remotely within soft tissues. It was performed through the combination of a transcranial magnetic stimulation device and a permanent magnet. A physical model based on Maxwell and Navier equations was developed. Experiments were performed on a cryogel phantom and a chicken breast sample. Using an ultrafast ultrasound scanner, shear waves of respective amplitudes of 5 and 0.5 μm were observed. Experimental and numerical results were in good agreement. This study constitutes the framework of an alternative shear wave elastography method.

Rescaled Local Interaction Simulation Approach for Shear Wave Propagation Modelling in Magnetic Resonance Elastography

Properties of soft biological tissues are increasingly used in medical diagnosis to detect various abnormalities, for example, in liver fibrosis or breast tumors. It is well known that mechanical stiffness of human organs can be obtained from organ responses to shear stress waves through Magnetic Resonance Elastography. The Local Interaction Simulation Approach is proposed for effective modelling of shear wave propagation in soft tissues. The results are validated using experimental data from Magnetic Resonance Elastography. These results show the potential of the method for shear wave propagation modelling in soft tissues. The major advantage of the proposed approach is a significant reduction of computational effort.

Suitability of poroelastic and viscoelastic mechanical models for high and low frequency MR elastography

PURPOSE

Descriptions of the structure of brain tissue as a porous cellular matrix support application of a poroelastic (PE) mechanical model which includes both solid and fluid phases. However, the majority of brain magnetic resonance elastography (MRE) studies use a single phase viscoelastic (VE) model to describe brain tissue behavior, in part due to availability of relatively simple direct inversion strategies for mechanical property estimation. A notable exception is low frequency intrinsic actuation MRE, where PE mechanical properties are imaged with a nonlinear inversion algorithm.

METHODS

This paper investigates the effect of model choice at each end of the spectrum of in vivo human brain actuation frequencies. Repeat MRE examinations of the brains of healthy volunteers were used to compare image quality and repeatability for each inversion model for both 50 Hz externally produced motion and ≈1 Hz intrinsic motions. Additionally, realistic simulated MRE data were generated with both VE and PE finite element solvers to investigate the effect of inappropriate model choice for ideal VE and PE materials.

RESULTS

In vivo, MRE data revealed that VE inversions appear more representative of anatomical structure and quantitatively repeatable for 50 Hz induced motions, whereas PE inversion produces better results at 1 Hz. Reasonable VE approximations of PE materials can be derived by equating the equivalent wave velocities for the two models, provided that the timescale of fluid equilibration is not similar to the period of actuation. An approximation of the equilibration time for human brain reveals that this condition is violated at 1 Hz but not at 50 Hz. Additionally, simulation experiments when using the "wrong" model for the inversion demonstrated reasonable shear modulus reconstructions at 50 Hz, whereas cross-model inversions at 1 Hz were poor quality. Attenuation parameters were sensitive to changes in the forward model at both frequencies, however, no spatial information was recovered because the mechanisms of VE and PE attenuation are different.

CONCLUSIONS

VE inversions are simpler with fewer unknown properties and may be sufficient to capture the mechanical behavior of PE brain tissue at higher actuation frequencies. However, accurate modeling of the fluid phase is required to produce useful mechanical property images at the lower frequencies of intrinsic brain motions.

EGF as a New Therapeutic Target for Medulloblastoma Metastasis

Medulloblastoma (MB) is a malignant pediatric brain tumor known for its aggressive metastatic potential. Despite the well-documented migration of MB cells to other parts of the brain and spinal column, MB chemotaxis is poorly understood. Herein, we examined the in vitro migratory and cellular responses of MB-derived cells to external signaling of Epidermal Growth Factor (EGF), hepatocyte growth factor (HGF), platelet-derived growth factor (PDGF-BB), and the stromal cell-derived factors 1-alpha (SDF-1). Experiments utilized transwell assays and immunocytochemistry to identify receptor activation in MB migration, and used a microfluidic platform to examine directionality, trajectory, and gradient-dependence of motile cells. Data illustrates that MB-derived cells respond strongly to EGF in a dosage and gradient-dependent manner with increased EGF-R activation, and show that high EGF gradient fields cause an increased number of cells to migrate longer directed distances. Our results provide evidence that EGF and its receptor play an important role than previously documented in MB chemotactic migration than previously documented and should be considered for developing migration-target therapies against MB metastasis.

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions

OBJECTIVE

The purpose of the article is to review the diagnostic performance of ultra-sound and MR elastography techniques for detection and staging of liver fibrosis, the main current clinical applications of elastography in the abdomen.

CONCLUSION

Technical and instrument-related factors and biologic and patient-related factors may constitute potential confounders of stiffness measurements for assessment of liver fibrosis. Future developments may expand the scope of elastography for monitoring liver fibrosis and predict complications of chronic liver disease.

Silicone breast phantoms for elastographic imaging evaluation

PURPOSE

Breast cancer is a major public health issue for women, and early detection significantly increases survival rate. Currently, there is increased research interest in elastographic soft-tissue imaging techniques based on the correlation between pathology and mechanical stiffness. Anthropomorphic breast phantoms are critical for ex vivo validation of emerging elastographic technologies. This research develops heterogeneous breast phantoms for use in testing elastographic imaging modalities.

METHODS

Mechanical property estimation of eight different elastomers is performed to determine storage moduli (E') and damping ratios (ζ) using a dynamic mechanical analyzer. Dynamic compression testing was carried out isothermally at room temperature over a range of 4-50 Hz. Silicone compositions with physiologically realistic storage modulus were chosen for mimicking skin adipose, cancerous tumors, and pectoral muscles and 13 anthropomorphic breast phantoms were constructed for ex vivo trials of digital image elastotomography (DIET) breast cancer screening system. A simpler fabrication was used to assess the possibility of multiple tumor detection using magnetic resonance elastography (MRE).

RESULTS

Silicone materials with ranges of storage moduli (E') from 2 to 570 kPa and damping ratios (ζ) from 0.03 to 0.56 were identified. The resulting phantoms were tested in two different elastographic breast cancer diagnostic modalities. A significant contrast was successfully identified between healthy tissues and cancerous tumors both in MRE and DIET.

CONCLUSIONS

The phantoms presented promise aid to researchers in elastographic imaging modalities for breast cancer detection and provide a foundation for silicone based phantom materials for mimicking soft tissues of other human organs.

Including spatial information in nonlinear inversion MR elastography using soft prior regularization

Tissue displacements required for mechanical property reconstruction in magnetic resonance elastography (MRE) are acquired in a magnetic resonance imaging (MRI) scanner, therefore, anatomical information is available from other imaging sequences. Despite its availability, few attempts to incorporate prior spatial information in the MRE reconstruction process have been reported. This paper implements and evaluates soft prior regularization (SPR), through which homogeneity in predefined spatial regions is enforced by a penalty term in a nonlinear inversion strategy. Phantom experiments and simulations show that when predefined regions are spatially accurate, recovered property values are stable for SPR weighting factors spanning several orders of magnitude, whereas inaccurate segmentation results in bias in the reconstructed properties that can be mitigated through proper choice of regularization weighting. The method was evaluated in vivo by estimating viscoelastic mechanical properties of frontal lobe gray and white matter for five repeated scans of a healthy volunteer. Segmentations of each tissue type were generated using automated software, and statistically significant differences between frontal lobe gray and white matter were found for both the storage modulus and loss modulus . Provided homogeneous property assumptions are reasonable, SPR produces accurate quantitative property estimates for tissue structures which are finer than the resolution currently achievable with fully distributed MRE.

Non-invasive characterization of polyurethane-based tissue constructs in a rat abdominal repair model using high frequency ultrasound elasticity imaging

The evaluation of candidate materials and designs for soft tissue scaffolds would benefit from the ability to monitor the mechanical remodeling of the implant site without the need for periodic animal sacrifice and explant analysis. Toward this end, the ability of non-invasive ultrasound elasticity imaging (UEI) to assess temporal mechanical property changes in three different types of porous, biodegradable polyurethane scaffolds was evaluated in a rat abdominal wall repair model. The polymers utilized were salt-leached scaffolds of poly(carbonate urethane) urea, poly(ester urethane) urea and poly(ether ester urethane) urea at 85% porosity. A total of 60 scaffolds (20 each type) were implanted in a full thickness muscle wall replacement in the abdomens of 30 rats. The constructs were ultrasonically scanned every 2 weeks and harvested at weeks 4, 8 and 12 for compression testing or histological analysis. UEI demonstrated different temporal stiffness trends among the different scaffold types, while the stiffness of the surrounding native tissue remained unchanged. The changes in average normalized strains developed in the constructs from UEI compared well with the changes of mean compliance from compression tests and histology. The average normalized strains and the compliance for the same sample exhibited a strong linear relationship. The ability of UEI to identify herniation and to characterize the distribution of local tissue in-growth with high resolution was also investigated. In summary, the reported data indicate that UEI may allow tissue engineers to sequentially evaluate the progress of tissue construct mechanical behavior in vivo and in some cases may reduce the need for interim time point animal sacrifice.

Multiresolution MR elastography using nonlinear inversion

PURPOSE

Nonlinear inversion (NLI) in MR elastography requires discretization of the displacement field for a finite element (FE) solution of the "forward problem", and discretization of the unknown mechanical property field for the iterative solution of the "inverse problem". The resolution requirements for these two discretizations are different: the forward problem requires sufficient resolution of the displacement FE mesh to ensure convergence, whereas lowering the mechanical property resolution in the inverse problem stabilizes the mechanical property estimates in the presence of measurement noise. Previous NLI implementations use the same FE mesh to support the displacement and property fields, requiring a trade-off between the competing resolution requirements.

METHODS

This work implements and evaluates multiresolution FE meshes for NLI elastography, allowing independent discretizations of the displacements and each mechanical property parameter to be estimated. The displacement resolution can then be selected to ensure mesh convergence, and the resolution of the property meshes can be independently manipulated to control the stability of the inversion.

RESULTS

Phantom experiments indicate that eight nodes per wavelength (NPW) are sufficient for accurate mechanical property recovery, whereas mechanical property estimation from 50 Hz in vivo brain data stabilizes once the displacement resolution reaches 1.7 mm (approximately 19 NPW). Viscoelastic mechanical property estimates of in vivo brain tissue show that subsampling the loss modulus while holding the storage modulus resolution constant does not substantially alter the storage modulus images. Controlling the ratio of the number of measurements to unknown mechanical properties by subsampling the mechanical property distributions (relative to the data resolution) improves the repeatability of the property estimates, at a cost of modestly decreased spatial resolution.

CONCLUSIONS

Multiresolution NLI elastography provides a more flexible framework for mechanical property estimation compared to previous single mesh implementations.

Brain mechanical property measurement using MRE with intrinsic activation

Many pathologies alter the mechanical properties of tissue. Magnetic resonance elastography (MRE) has been developed to noninvasively characterize these quantities in vivo. Typically, small vibrations are induced in the tissue of interest with an external mechanical actuator. The resulting displacements are measured with phase contrast sequences and are then used to estimate the underlying mechanical property distribution. Several MRE studies have quantified brain tissue properties. However, the cranium and meninges, especially the dura, are very effective at damping externally applied vibrations from penetrating deeply into the brain. Here, we report a method, termed 'intrinsic activation', that eliminates the requirement for external vibrations by measuring the motion generated by natural blood vessel pulsation. A retrospectively gated phase contrast MR angiography sequence was used to record the tissue velocity at eight phases of the cardiac cycle. The velocities were numerically integrated via the Fourier transform to produce the harmonic displacements at each position within the brain. The displacements were then reconstructed into images of the shear modulus based on both linear elastic and poroelastic models. The mechanical properties produced fall within the range of brain tissue estimates reported in the literature and, equally important, the technique yielded highly reproducible results. The mean shear modulus was 8.1 kPa for linear elastic reconstructions and 2.4 kPa for poroelastic reconstructions where fluid pressure carries a portion of the stress. Gross structures of the brain were visualized, particularly in the poroelastic reconstructions. Intra-subject variability was significantly less than the inter-subject variability in a study of six asymptomatic individuals. Further, larger changes in mechanical properties were observed in individuals when examined over time than when the MRE procedures were repeated on the same day. Cardiac pulsation, termed intrinsic activation, produces sufficient motion to allow mechanical properties to be recovered. The poroelastic model is more consistent with the measured data from brain at low frequencies than the linear elastic model. Intrinsic activation allows MRE to be performed without a device shaking the head so the patient notices no differences between it and the other sequences in an MR examination.

Linear and nonlinear elastic modulus imaging: an application to breast cancer diagnosis

We reconstruct the in vivo spatial distribution of linear and nonlinear elastic parameters in ten patients with benign (five) and malignant (five) tumors. The mechanical behavior of breast tissue is represented by a modified Veronda-Westmann model with one linear and one nonlinear elastic parameter. The spatial distribution of these elastic parameters is determined by solving an inverse problem within the region of interest (ROI). This inverse problem solution requires the knowledge of the displacement fields at small and large strains. The displacement fields are measured using a free-hand ultrasound strain imaging technique wherein, a linear array ultrasound transducer is positioned on the breast and radio frequency echo signals are recorded within the ROI while the tissue is slowly deformed with the transducer. Incremental displacement fields are determined from successive radio-frequency frames by employing cross-correlation techniques. The rectangular regions of interest were subjectively selected to obtain low noise displacement estimates and therefore were variables that ranged from 346 to 849.6 mm2 . It is observed that malignant tumors stiffen at a faster rate than benign tumors and based on this criterion nine out of ten tumors were correctly classified as being either benign or malignant.

Multifrequency inversion in magnetic resonance elastography

Time-harmonic shear wave elastography is capable of measuring viscoelastic parameters in living tissue. However, finite tissue boundaries and waveguide effects give rise to wave interferences which are not accounted for by standard elasticity reconstruction methods. Furthermore, the viscoelasticity of tissue causes dispersion of the complex shear modulus, rendering the recovered moduli frequency dependent. Therefore, we here propose the use of multifrequency wave data from magnetic resonance elastography (MRE) for solving the inverse problem of viscoelasticity reconstruction by an algebraic least-squares solution based on the springpot model. Advantages of the method are twofold: (i) amplitude nulls appearing in single-frequency standing wave patterns are mitigated and (ii) the dispersion of storage and loss modulus with drive frequency is taken into account by the inversion procedure, thereby avoiding subsequent model fitting. As a result, multifrequency inversion produces fewer artifacts in the viscoelastic parameter map than standard single-frequency parameter recovery and may thus support image-based viscoelasticity measurement. The feasibility of the method is demonstrated by simulated wave data and MRE experiments on a phantom and in vivo human brain. Implemented as a clinical method, multifrequency inversion may improve the diagnostic value of time-harmonic MRE in a large variety of applications.

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.

An H(∞) approach for elasticity properties reconstruction

PURPOSE

Quantification of object elasticity properties has significant technical implications as well as important practical applications, such as medical disease diagnosis. In general, given noisy measurements on the kinematic states of the objects from imaging data, the aim is to recover the elasticity parameters for assumed material constitutive models of the objects. The implementation is complicated caused by the large dimensionality of the parameters.

METHODS

Various versions of the least-square (LS) methods have been widely used, which, however, do not perform well under reasonably realistic levels of disturbances. Another popular strategy, based on the extended Kalman filter (EKF), is also far from optimal and subject to divergence if either the initializations are poor or the noises are not Gaussian. In this paper, the authors propose a robust system identification paradigm for the quantitative analysis of object elasticity. It is derived and extended from the H(∞) filtering principles and is particularly powerful for real-world situations where the types and levels of the disturbances are unknown.

RESULTS

Using synthetic data, the authors investigate the sensitivity of the strategies toward different types (Gaussian and Poisson) and levels of noises, as well as various initializations. The experimental results show consistently superior performance of the proposed method over the LS and EKF algorithms in reliably identifying object elastic modulus distributions.

CONCLUSIONS

Results from phase contrast imaging data of canine hearts and human MRI data are also presented, which demonstrate the power of the framework.

An octahedral shear strain-based measure of SNR for 3D MR elastography

A signal-to-noise ratio (SNR) measure based on the octahedral shear strain (the maximum shear strain in any plane for a 3D state of strain) is presented for magnetic resonance elastography (MRE), where motion-based SNR measures are commonly used. The shear strain, γ, is directly related to the shear modulus, μ, through the definition of shear stress, τ = μγ. Therefore, noise in the strain is the important factor in determining the quality of motion data, rather than the noise in the motion. Motion and strain SNR measures were found to be correlated for MRE of gelatin phantoms and the human breast. Analysis of the stiffness distributions of phantoms reconstructed from the measured motion data revealed a threshold for both strain and motion SNR where MRE stiffness estimates match independent mechanical testing. MRE of the feline brain showed significantly less correlation between the two SNR measures. The strain SNR measure had a threshold above which the reconstructed stiffness values were consistent between cases, whereas the motion SNR measure did not provide a useful threshold, primarily due to rigid body motion effects.

The feasibility of endorectal MR elastography for prostate cancer localization

The objectives of this study were to evaluate the feasibility of using a rigid radio-frequency receiver endorectal coil for intracavitary prostate magnetic resonance elastography (MRE) and to demonstrate the capability of this technique for generating stiffness maps over a typical prostate volume. An endorectal coil is currently used to help improve the signal-to-noise ratio of images acquired with multiparametric magnetic resonance imaging. We propose that this same coil could also serve to generate shear waves in the prostate gland during imaging, opening up the possibility of incorporating prostate stiffness characterization into multiparametric magnetic resonance imaging. Prostate cancer has been shown to change the elasticity of tissue, suggesting that stiffness imaging (elastography) may provide supplementary diagnostic information. A rigid endorectal coil was mechanically coupled to a piezoceramic actuator and used to investigate full volume (27 slices, 2-mm thick) endorectal MRE in a prostate mimicking phantom. The low-amplitude vibrations (± 8-38 μm displacements) necessary to perform endorectal MRE did not affect the signal-to noise ratio of the coil and endorectal MRE was capable of resolving 0.1 cc (0.6 cm diameter) spherical inclusion volumes. Therefore, the results of this study, in combination with current clinical practice, motivate clinical evaluation of endorectal MRE in patients.

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.

The performance of steady-state harmonic magnetic resonance elastography when applied to viscoelastic materials

PURPOSE

The clinical efficacy of breast elastography may be limited when the authors employ the assumption that soft tissues exhibit linear, frequency-independent isotropic mechanical properties during the recovery of shear modulus. Thus, the purpose of this research was to evaluate the degradation in performance incurred when linear-elastic MR reconstruction methods are applied to phantoms that are fabricated using viscoelastic materials.

METHODS

To develop phantoms with frequency-dependent mechanical properties, the authors measured the complex modulus of two groups of cylindrical-shaped gelatin samples over a wide frequency range (up to 1 kHz) with the established principles of time-temperature superposition (TTS). In one group of samples, the authors added varying amounts of agar (1%-4%); in the other group, the authors added varying amounts of sucrose (2.5%-20%). To study how viscosity affected the performance of the linear-elastic reconstruction method, the authors constructed an elastically heterogeneous MR phantom to simulate the case where small viscoelastic lesions were surrounded by relatively nonviscous breast tissue. The breast phantom contained four linear, viscoelastic spherical inclusions (10 mm diameter) that were embedded in normal gelatin. The authors imaged the breast phantom with a clinical prototype of a MRE system and recovered the shear-modulus distribution using the overlapping-subzone-linear-elastic image-reconstruction method. The authors compared the recovered shear modulus to that measured using the TTS method.

RESULTS

The authors demonstrated that viscoelastic phantoms could be fabricated by including sucrose in the gelation process and that small viscoelastic inclusions were visible in MR elastograms recovered using a linear-elastic MR reconstruction process; however, artifacts that degraded contrast and spatial resolution were more prominent in highly viscoelastic inclusions. The authors also established that the accuracy of the MR elastograms depended on the degree of viscosity that the inclusion exhibited.

CONCLUSIONS

The results demonstrated that reconstructing shear modulus from other constitutive laws, such as viscosity, should improve both the accuracy and quality of MR elastograms of the breast.

Effects of frequency- and direction-dependent elastic materials on linearly elastic MRE image reconstructions

The mechanical model commonly used in magnetic resonance elastography (MRE) is linear elasticity. However, soft tissue may exhibit frequency- and direction-dependent (FDD) shear moduli in response to an induced excitation causing a purely linear elastic model to provide an inaccurate image reconstruction of its mechanical properties. The goal of this study was to characterize the effects of reconstructing FDD data using a linear elastic inversion (LEI) algorithm. Linear and FDD phantoms were manufactured and LEI images were obtained from time-harmonic MRE acquisitions with variations in frequency and driving signal amplitude. LEI responses to artificially imposed uniform phase shifts in the displacement data from both purely linear elastic and FDD phantoms were also evaluated. Of the variety of FDD phantoms considered, LEI appeared to tolerate viscoelastic data-model mismatch better than deviations caused by poroelastic and anisotropic mechanical properties in terms of visual image contrast. However, the estimated shear modulus values were substantially incorrect relative to independent mechanical measurements even in the successful viscoelastic cases and the variations in mean values with changes in experimental conditions associated with uniform phase shifts, driving signal frequency and amplitude were unpredictable. Overall, use of LEI to reconstruct data acquired in phantoms with FDD material properties provided biased results under the best conditions and significant artifacts in the worst cases. These findings suggest that the success with which LEI is applied to MRE data in tissue will depend on the underlying mechanical characteristics of the tissues and/or organs systems of clinical interest.

Magnetic resonance poroelastography: an algorithm for estimating the mechanical properties of fluid-saturated soft tissues

Magnetic resonance poroelastography (MRPE) is introduced as an alternative to single-phase model-based elastographic reconstruction methods. A 3-D finite element poroelastic inversion algorithm was developed to recover the mechanical properties of fluid-saturated tissues. The performance of this algorithm was assessed through a variety of numerical experiments, using synthetic data to probe its stability and sensitivity to the relevant model parameters. Preliminary results suggest the algorithm is robust in the presence of noise and capable of producing accurate assessments of the underlying mechanical properties in simulated phantoms. Furthermore, a 3-D time-harmonic motion field was recorded for a poroelastic phantom containing a single cylindrical inclusion and used to assess the feasibility of MRPE image reconstruction from experimental data. The elastograms obtained from the proposed poroelastic algorithm demonstrate significant improvement over linearly elastic MRE images generated using the same data. In addition, MRPE offers the opportunity to estimate the time-harmonic pressure field resulting from tissue excitation, highlighting the potential for its application in the diagnosis and monitoring of disease processes associated with changes in interstitial pressure.

[Elastosonography of thyroid lesions]

While ultrasound is the imaging modality of choice for diagnosis of thyroid lesions, characterization remains limited and tissue diagnosis frequently is required for management. The availability of additional tools such as elastography may improve lesion characterization and direct management.

MATERIALS AND METHODS

A total of 96 patients (11 males and 85 females; 58+/-24 years) referred for fine needle aspiration (FNA) of mainly solid thyroid nodules 9-32 mm in diameter underwent conventional US and elastosonography. Results on elastography were correlated with histological results from FNA and classified as follows: suspected malignant lesion, suspected benign lesion, suspicious, indeterminate.

RESULTS

The nodules were classified as follows: 95 nodules were soft (classes I and II) and 13 nodules were hard (classes III and IV). No cancers were detected in class and II lesions and 6 cancers were detected in class III and IV lesions. FNA provided insufficient cellular material for diagnosis in 5 class I-II nodules and 2 class III-IV nodules.

CONCLUSION

Real-time elastosonography may be a useful adjunct to conventional US in the evaluation and characterization of thyroid nodules allowing identification of patients at high risk of malignancy for whom tissue diagnosis and/or close follow-up is required.

Optimized motion estimation for MRE data with reduced motion encodes

Motion estimation is an essential step common to all magnetic resonance elastography (MRE) methods. For dynamic techniques, the motion is obtained from a sinusoidal fit of the image phase at multiple, uniformly spaced relative phase offsets, phi, between the motion and the motion encoding gradients (MEGs). Generally, eight values of phi sampled at the Nyquist interval pi/4 over [0, 2pi). We introduce a method, termed reduced motion encoding (RME), that reduces the number of phi required, thereby reducing the imaging time for an MRE acquisition. A frequency-domain algorithm was implemented using the discrete Fourier transform (DFT) to derive the general least-squares solution for the motion amplitude and phase given an arbitrary number of phi. A closed form representation of the condition number of the transformation matrix which is used for estimating motion was introduced to determine the sensitivity to noise for different sampling patterns of phi. Simulation results confirmed the minimum error sampling patterns suggested from the condition number maps. The minimum noise in the motion estimate is obtained when the sampled phi are essentially evenly distributed over the range [0, pi) with an interval pi/n, where n is the number of phi sampled, or alternatively with an interval 2pi/n over the range [0, 2pi) which represents the Nyquist interval. Simulations also show that the noise level decreases as n increases as expected. The decrease in noise is the largest when n is small and it becomes less significant as n increases. The algorithm also makes it possible to estimate the motion from only two values of phi, which cannot be accomplished with traditional methods because sampling at the Nyquist interval is indeterminate. Finally, noise levels in motion estimated from phantom studies and in vivo results taken with different n agreed with that predicted by simulation and condition number calculations.

Non-invasive measurement of brain viscoelasticity using magnetic resonance elastography

The purpose of this work was to develop magnetic resonance elastography (MRE) for the fast and reproducible measurement of spatially averaged viscoelastic constants of living human brain. The technique was based on a phase-sensitive echo planar imaging acquisition. Motion encoding was orthogonal to the image plane and synchronized to intracranial shear vibrations at driving frequencies of 25 and 50 Hz induced by a head-rocker actuator. Ten time-resolved phase-difference wave images were recorded within 60 s and analyzed for shear stiffness and shear viscosity. Six healthy volunteers (six men; mean age 34.5 years; age range 25-44 years) underwent 23-39 follow-up MRE studies over a period of 6 months. Interindividual mean +/- SD shear moduli and shear viscosities were found to be 1.17 +/- 0.03 kPa and 3.1 +/- 0.4 Pas for 25 Hz and 1.56 +/- 0.07 kPa and 3.4 +/- 0.2 Pas for 50 Hz, respectively (P < or = 0.01). The intraindividual range of shear modulus data was 1.01-1.31 kPa (25 Hz) and 1.33-1.77 kPa (50 Hz). The observed modulus dispersion indicates a limited applicability of Voigt's model to explain viscoelastic behavior of brain parenchyma within the applied frequency range. The narrow distribution of data within small confidence intervals demonstrates excellent reproducibility of the experimental protocol. The results are necessary as reference data for future comparisons between healthy and pathological human brain viscoelastic data.

In vivo determination of hepatic stiffness using steady-state free precession magnetic resonance elastography

OBJECTIVE

The objective of this study was to introduce an magnetic resonance elastography (MRE) protocol based on fractional motion encoding and planar wave acquisition for rapid measurements of in vivo human liver stiffness.

MATERIALS AND METHODS

Vibrations of a remote actuator membrane were fed by a rigid rod to the patient's surface beneath the right costal arch resulting in axial shear deflections of the liver. Data acquisition was performed using a balanced steady-state free precession (bSSFP) sequence incorporating oscillating gradients for motion sensitization. Tissue vibrations of frequency fv = 51 Hz were tuned by twice the sequence repetition time (1/fv = 2TR). Twenty axial images acquired by time-resolved through-plane wave encoding were used for planar elasticity reconstruction. The MRE data acquisition was achieved within 4 breathholds of 17 seconds each. The method was applied to 12 healthy volunteers and 2 patients with diffuse liver disease (fibrosis grade 3).

RESULTS

MRE data acquisition was successful in all volunteers and patients. The elastic moduli were measured with values between 1.99 +/- 0.16 and 5.77 +/- 0.88 kPa. Follow-up studies demonstrated the reproducibility of the method and revealed a difference of 0.74 +/- 0.47 kPa (P < 0.05) between the hepatic stiffness of 2 healthy male volunteers.

CONCLUSION

bSSFP combined with fractional MRE enables rapid measurement of liver stiffness in vivo. The used actuation principle supports a 2-dimensional analysis of the strain wave field captured by axial wave images. The measured data indicate individual variations of hepatic stiffness in healthy volunteers.

Performance analysis of steady-state harmonic elastography

Shear modulus estimation can be confounded by the ill-posed nature of the inverse elasticity problem. In this paper, we report the results of experiments conducted on simulated and gelatin phantoms to investigate the effect of various parameters (i.e., regularization, spatial filtering and the subzone generation process) associated with shear modulus reconstruction on the statistical accuracy (mean squared error), and image quality (i.e., contrast and spatial resolution) of the recovered mechanical properties. The results indicate several interesting observations. Firstly, the intrinsic spatial resolution of magnetic resonance elastography (MRE) is dependent on both regularization and spatial filtering. Secondly, the elastographic contrast-to-noise ratio (CNR(e)) increases with increasing regularization and spatial filtering, but it was not affected by the zoning parameters (i.e., the subzones and the extent of the overlap). Thirdly, the statistical accuracy (MSE) of the recovered property improved with increasing regularization, and spatial filtering weight, but the size of the subdomains and their overlap had no significant effect.

Elastic modulus imaging: some exact solutions of the compressible elastography inverse problem

We consider several inverse problems motivated by elastography. Given the (possibly transient) displacement field measured everywhere in an isotropic, compressible, linear elastic solid, and given density rho, determine the Lamé parameters lambda and mu. We consider several special cases of this problem: (a) for mu known a priori, lambda is determined by a single deformation field up to a constant. (b) Conversely, for lambda known a priori, mu is determined by a single deformation field up to a constant. This includes as a special case that for which the term [see text]. (c) Finally, if neither lambda nor mu is known a priori, but Poisson's ratio nu is known, then mu and lambda are determined by a single deformation field up to a constant. This includes as a special case plane stress deformations of an incompressible material. Exact analytical solutions valid for 2D, 3D and transient deformations are given for all cases in terms of quadratures. These are used to show that the inverse problem for mu based on the compressible elasticity equations is unstable in the limit lambda --> infinity. Finally, we use the exact solutions as a basis to compute non-trivial modulus distributions in a simulated example.

Fractional encoding of harmonic motions in MR elastography

In MR elastography (MRE) shear waves are magnetically encoded by bipolar gradients that usually oscillate with the same frequency fv as the mechanical vibration. As a result, both the repetition time (TR) and echo time (TE) of such an MRE sequence are greater than the vibration period 1/fv. This causes long acquisition times and considerable signal dephasing in tissue with short transverse relaxation times. Here we propose a reverse concept with TR<or=1/fv which we call "fractional" MRE, i.e., only a fraction of one vibration cycle per TR, can be used for motion sensitization. The benefit of fractional MRE is twofold: 1) acquisition times in seconds can be achieved for a single-phase difference wave image, and 2) materials that combine low elasticity, high viscosity, and short T2* relaxation times show an increased phase-to-noise ratio (PNR). A twofold increase of the phase signal is predicted for liver-like materials. Volunteer studies performed in liver and biceps show the benefit of fractional MRE. Furthermore, we demonstrate the feasibility of the technique for in vivo myocardial MRE by visualizing transverse wave propagation in the interventricular septum (IVS).

Three-dimensional analysis of shear wave propagation observed by in vivo magnetic resonance elastography of the brain

Dynamic magnetic resonance elastography (MRE) is a non-invasive method for the quantitative determination of the mechanical properties of soft tissues in vivo. In MRE, shear waves are generated in the tissue and visualized using phase-sensitive MR imaging methods. The resulting two-dimensional (2-D) wave images can reveal in-plane elastic properties when possible geometrical biases of the wave patterns are taken into account. In this study, 3-D MRE experiments of in vivo human brain are analyzed to gain knowledge about the direction of wave propagation and to deduce in-plane elastic properties. The direction of wave propagation was determined using a new algorithm which identifies minimal wave velocities along rays from the surface into the brain. It was possible to quantify biases of the elastic parameters due to projections onto coronal, sagittal and transversal image planes in 2-D MRE. It was found that the in-plane shear modulus is increasingly overestimated when the image slice is displaced from narrow slabs of 2-5cm through the center of the brain. The mean shear modulus of the brain was deduced from 4-D wave data with about 3.5kPa. Using the proposed slice positions in 2-D MRE, this shear modulus can be reproduced with an acceptable error within a fraction of the full 3-D examination time.

Anisotropic elastography for local passive properties and active contractility of myocardium from dynamic heart imaging sequence

Major heart diseases such as ischemia and hypertrophic myocardiopathy are accompanied with significant changes in the passive mechanical properties and active contractility of myocardium. Identification of these changes helps diagnose heart diseases, monitor therapy, and design surgery. A dynamic cardiac elastography (DCE) framework is developed to assess the anisotropic viscoelastic passive properties and active contractility of myocardial tissues, based on the chamber pressure and dynamic displacement measured with cardiac imaging techniques. A dynamic adjoint method is derived to enhance the numerical efficiency and stability of DCE. Model-based simulations are conducted using a numerical left ventricle (LV) phantom with an ischemic region. The passive material parameters of normal and ischemic tissues are identified during LV rapid/reduced filling and artery contraction, and those of active contractility are quantified during isovolumetric contraction and rapid/reduced ejection. It is found that quasistatic simplification in the previous cardiac elastography studies may yield inaccurate material parameters.

Magnetic resonance elastography of the plantar fat pads: Preliminary study in diabetic patients and asymptomatic volunteers

OBJECTIVE

To test the feasibility of applying the magnetic resonance elastography (MRE) technique to map the elastic modulus of the plantar fat pads in diabetic and nondiabetic subjects.

METHODS

A prototype MRE imaging apparatus was used to produce quantitative maps of the heel fat pad in a pilot study of 12 volunteers and 4 patients with diabetes with neuropathy. Anatomic images corresponding to MRE maps allowed precise selection of regions of interest in the fat.

RESULTS

Magnetic resonance elastograms of the heel fat pads were successfully created; mean measurements in the volunteers and the diabetic patients were 4.85 and 5.26 kPa, respectively.

CONCLUSION

It is feasible to perform MRE on the plantar fat pads and to produce elasticity maps. The trend toward stiffer fat pads, as demonstrated in patients with diabetes, suggests that the fat pads were qualitatively different. Magnetic resonance elastography offers great potential to investigate the mechanical properties of soft tissues in vivo noninvasively.