Ultrasound tissue characterization of breast biopsy specimens

Ultrasound Tomography

Ultrasound tomography (USCT) is a promising imaging modality, mainly aiming at early diagnosis of breast cancer. It provides three-dimensional, reproducible images of higher quality than conventional ultrasound methods and additionally offers quantitative information on tissue properties. This chapter provides an introduction to the background and history of USCT, followed by an overview of image reconstruction algorithms and system design. It concludes with a discussion of current and future applications as well as limitations and their potential solutions.

Suite of 3D test objects for performance assessment of hybrid photoacoustic-ultrasound breast imaging systems

SIGNIFICANCE

During the development and early testing phases of new photoacoustic (PA) breast imaging systems, several choices need to be made in aspects of system design and measurement sequences. Decision-making can be complex for state-of-the-art systems such as 3D hybrid photoacoustic-ultrasound (PA-US) breast imagers intended for multispectral quantitative imaging. These systems have a large set of design choices and system settings that affect imaging performance in different ways and often require trade-offs. Decisions have to be made carefully as they can strongly influence the imaging performance.

AIM

A systematic approach to assess the influence of various choices on the imaging performance in carefully controlled laboratory situations is crucial before starting with human studies. Test objects and phantoms are used for first imaging studies, but most reported structures have a 2D geometry and are not suitable to assess all the image quality characteristics (IQCs) of 3D hybrid PA-US systems.

APPROACH

Our work introduces a suite of five test objects designed for hybrid PA-US systems with a 3D detection aperture. We present the test object designs and production protocols and explain how they can be used to study various performance measures. To demonstrate the utility of the developed objects, measurements are made with an existing tomographic PA system.

RESULTS

Two test objects were developed for measurements of the US detectors' impulse responses and light distribution on the breast surface. Three others were developed to assess image quality and quantitative accuracy of the PA and US modes. Three of the five objects were imaged to demonstrate their use.

CONCLUSIONS

The developed test objects allow one to study influences of various choices in design and system settings. With this, IQCs can be assessed as a function of measurement sequence settings for the PA and US modes in a controlled way. Systematic studies and measurements using these objects will help to optimize various system settings and measurement protocols in laboratory situations before embarking on human studies.

Development of a noninvasive HIFU treatment for breast adenocarcinomas using a toroidal transducer based on preliminary attenuation measurements

Breast cancer is the most commonly diagnosed type of cancer among women. For the last fifteen years, treatments that are less invasive than lumpectomy, such as high-intensity focused ultrasound (HIFU) therapy, have been developed, with encouraging results. In this study, a toroidal HIFU transducer was used to create lesions of at least 2 cm in diameter within less than one minute of treatment. The toroidal HIFU transducer created two focal zones that led to large, fast and homogeneous ablations (10.5 cc/min). The experiments were conducted in 30 human samples of normal breast tissues recovered from mastectomies to measure acoustic attenuation (N = 30), and then, HIFU lesions were created (N = 15). Eight HIFU ablations were performed to evaluate the reproducibility of the lesions. HIFU lesions were created in 45 s with a toroidal HIFU transducer working at 2.5 MHz. The longest and shortest axes of the HIFU lesions were 21.7 ± 3.1 mm and 23.5 ± 3.3 mm respectively, corresponding to an average volume of 7.3 ± 1.4 cm³. These HIFU lesions were performed at an average depth of 19.0 ± 1.5 mm, while the integrity of the skin was preserved. The HIFU-treated breast tissues had a higher level of attenuation (0.57 ± 0.11 Np.cm^-1.MHz^-1) when compared to the untreated tissues (0.21 ± 0.04 Np.cm^-1.MHz^-1). This study shows the feasibility of a fast and fully noninvasive treatment using a toroidal transducer for breast tumors measuring up to 15 mm in diameter.

Semi-anthropomorphic photoacoustic breast phantom

Imaging parameters of photoacoustic breast imaging systems such as the spatial resolution and imaging depth are often characterized with phantoms. These objects usually contain simple structures in homogeneous media such as absorbing wires or spherical objects in scattering gels. While these kinds of basic phantoms are uncluttered and useful, they do not challenge the system as much as a breast does, and can thereby overestimate the system's performance. The female breast is a complex collection of tissue types, and the acoustic and optical attenuation of these tissues limit the imaging depth, the resolution and the ability to extract quantitative information. For testing and challenging photoacoustic breast imaging systems to the full extent before moving to in vivo studies, a complex breast phantom which simulates the breast's most prevalent tissues is required. In this work we present the first three dimensional multi-layered semi-anthropomorphic photoacoustic breast phantom. The phantom aims to simulate skin, fat, fibroglandular tissue and blood vessels. The latter three are made from custom polyvinyl chloride plastisol (PVCP) formulations and are appropriately doped with additives to obtain tissue realistic acoustic and optical properties. Two tumors are embedded, which are modeled as clusters of small blood vessels. The PVCP materials are surrounded by a silicon layer mimicking the skin. The tissue mimicking materials were cast into the shapes and sizes expected in the breast using 3D-printed moulds developed from a magnetic resonance imaging segmented numerical breast model. The various structures and layers were assembled to obtain a realistic breast morphology. We demonstrate the phantom's appearance in both ultrasound imaging as photoacoustic tomography and make a comparison with a photoacoustic image of a real breast. A good correspondence is observed, which confirms the phantom's usefulness.

Biologically relevant photoacoustic imaging phantoms with tunable optical and acoustic properties

Established medical imaging technologies such as magnetic resonance imaging and computed tomography rely on well-validated tissue-simulating phantoms for standardized testing of device image quality. The availability of high-quality phantoms for optical-acoustic diagnostics such as photoacoustic tomography (PAT) will facilitate standardization and clinical translation of these emerging approaches. Materials used in prior PAT phantoms do not provide a suitable combination of long-term stability and realistic acoustic and optical properties. Therefore, we have investigated the use of custom polyvinyl chloride plastisol (PVCP) formulations for imaging phantoms and identified a dual-plasticizer approach that provides biologically relevant ranges of relevant properties. Speed of sound and acoustic attenuation were determined over a frequency range of 4 to 9 MHz and optical absorption and scattering over a wavelength range of 400 to 1100 nm. We present characterization of several PVCP formulations, including one designed to mimic breast tissue. This material is used to construct a phantom comprised of an array of cylindrical, hemoglobin-filled inclusions for evaluation of penetration depth. Measurements with a custom near-infrared PAT imager provide quantitative and qualitative comparisons of phantom and tissue images. Results indicate that our PVCP material is uniquely suitable for PAT system image quality evaluation and may provide a practical tool for device validation and intercomparison.

Acoustic Properties of Breast Fat

OBJECTIVES

The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) atlas for ultrasound (US) qualitatively describes the echogenicity and attenuation of a mass, where fat lobules serve as a standard for comparison. This study aimed to estimate acoustic properties of breast fat under clinical imaging conditions to determine the degree to which properties vary among patients.

METHODS

Twenty-four women with solid breast masses scheduled for biopsy were scanned with a Siemens S2000 scanner and 18L6 linear array transducer (Siemens Medical Solutions, Malvern, PA). Offline analysis estimated the attenuation coefficient and backscatter coefficients (BSCs) from breast fat using the reference phantom method. The average BSC was calculated over 6 to 12 MHz to objectively quantify the BI-RADS US echo pattern descriptor, and effective scatterer diameters were also estimated.

RESULTS

A power law fit to the attenuation coefficient versus frequency yielded an attenuation coefficient of 1.28 dB·cm(-1) MHz(-0.73). The mean attenuation coefficient versus frequency slope ± SD at 7 MHz was 0.73 ± 0.23 dB·cm(-1) MHz(-1), in agreement with previously reported values. The BSC versus frequency showed close agreement among all patients, both in magnitude and frequency dependence, with a power law fit of (0.6 ± 0.25) ×10(-4) sr(-1) cm(-1) MHz(-2.49). The average backscatter in the 6-12-MHz range was 0.004 ± 0.002 sr(-1) cm(-1). The mean effective scatterer diameter for fat was 60.2 ± 9.5 μm.

CONCLUSIONS

The agreement in parameter estimates for breast fat among these patients supports the use of fat as a standard for comparison with tumors. Results also suggest that objective quantification of these BI-RADS US descriptors may reduce subjectivity when interpreting B-mode image data.

Age-related ultrasonic properties of breast tissue in vivo

The aim of the current work was to quantify the ultrasonic properties of the whole breast in vivo as a function of age. Forty-four women were scanned using a computerized ultrasonic scanner developed in our laboratory. Raster scans in two orthogonal views, mediolateral and craniocaudal, were obtained using the ultrasonic through-transmission method. By combining the information from the two views, we estimated two acoustic properties: speed of sound and attenuation coefficient. On the basis of the results, both the attenuation coefficient and the speed of sound follow a three-phase age-related pattern. During the first phase, which corresponds to ages 20 to 35 y, both properties decrease with time and then remain roughly unchanged until about 55 y. During the third phase corresponding to ages >55 y, values decrease again with time. The mean speed of sound decreases from 1504 ± 35 m/s at <30 y to 1452 ± 9 m/s at >60 y (p < 0.01), and the attenuation coefficient decreases from 1.27 ± 0.32 to 0.96 ± 0.13 dB/cm/MHz (p < 0.03), respectively. In conclusion, both the ultrasonic speed of sound and the attenuation coefficient of breast tissue are age related. Both parameters decrease during life, markedly during the first and third phases. These changes may be attributed to anatomic and physiologic changes associated with reproductivity and menopause.

Measurement of bioelectric and acoustic profile of breast tissue using hybrid magnetoacoustic method for cancer detection

This paper proposes a novel hybrid magnetoacoustic measurement (HMM) system aiming at breast cancer detection. HMM combines ultrasound and magnetism for the simultaneous assessment of bioelectric and acoustic profiles of breast tissue. HMM is demonstrated on breast tissue samples, which are exposed to 9.8 MHz ultrasound wave with the presence of a 0.25 Tesla static magnetic field. The interaction between the ultrasound wave and the magnetic field in the breast tissue results in Lorentz Force that produces a magnetoacoustic voltage output, proportional to breast tissue conductivity. Simultaneously, the ultrasound wave is sensed back by the ultrasound receiver for tissue acoustic evaluation. Experiments are performed on gel phantoms and real breast tissue samples harvested from laboratory mice. Ultrasound wave characterization results show that normal breast tissue experiences higher attenuation compared with cancerous tissue. The mean magnetoacoustic voltage results for normal tissue are lower than that for the cancerous tissue group. In conclusion, the combination of acoustic and bioelectric measurements is a promising approach for breast cancer diagnosis.

Breast ultrasound tomography versus MRI for clinical display of anatomy and tumor rendering: preliminary results

OBJECTIVE

The objective of our study was to determine the clinical display thresholds of an ultrasound tomography prototype relative to MRI for comparable visualization of breast anatomy and tumor rendering.

SUBJECTS AND METHODS

Thirty-six women were imaged with MRI and our ultrasound tomography prototype. The ultrasound tomography scan generated reflection, sound-speed, and attenuation images. The reflection images were fused with the components of the sound-speed and attenuation images that achieved thresholds to represent parenchyma or solid masses using an image arithmetic process. Qualitative and quantitative comparisons of MRI and ultrasound tomography clinical images were used to identify anatomic similarities and optimized thresholds for tumor shapes and volumes.

RESULTS

Thresholding techniques generated ultrasound tomography images comparable to MR images for visualizing fibrous stroma, parenchyma, fatty tissues, and tumors. In 25 patients, tumors were cancerous and in 11, benign. Optimized sound-speed thresholds of 1.46±0.1 and 1.52±0.03 km/s were identified to best represent the extent of fibroglandular tissue and solid masses, respectively. An arithmetic combination of attenuation images using a threshold of 0.16±0.04 dB/cm (mean±SD) further characterized benign from malignant masses. No significant difference in tumor volume was noted between benign or malignant masses by ultrasound tomography or MRI (p>0.1) using these universal thresholds.

CONCLUSION

Ultrasound tomography is able to image and render breast tissues in a manner comparable to MRI. Using universal ultrasound tomography threshold values for rendering the size and distribution of benign and malignant tissues appears feasible without IV contrast material.

Analysis of 2-D motion tracking in ultrasound with dual transducers

We study displacement and strain measurement error of dual transducers (two linear arrays, aligned orthogonally and coplanar). Displacements along the beam of each transducer are used to obtain measurements in two-dimensions. Simulations (5MHz) and experiments (10MHz) are compared to measurements with a single linear array, with and without angular compounding. Translation simulations demonstrate factors of 1.07 larger and 8.0 smaller biases in the axial and lateral directions respectively, for dual transducers compared to angular compounding. As the angle between dual transducers decreases from 90° to 40°, for 1% compression simulations, the lateral RMS error ranges from 2.1 to 3.9μm compared to 9μm with angular compounding. Simulation of dual transducer misalignment of 1mm and 2° result in errors of less than 9μm. Experiments demonstrate factors of 3.0 and 5.2 lower biases for dual transducers in the axial and lateral directions respectively compared to angular compounding.

Benign versus malignant classification of breast tumors based on the the PLSN model for the ultrasound RF echo and homomorphic filtering

The Power-law Shot Noise (PLSN) model has been recently proposed for modeling the ultrasound radio-frequency echo. According to it, the spectrum of the in-phase/quadrature/envelope components are power-law functions. The corresponding power-law exponents were shown to possess good tissue characterization ability. A crucial step in the computation of in-phase/quadrature/envelope components is the estimation of the echo center frequency at different depths. We here propose a robust way of estimating the center frequency. We employ a well known convolutive model for the rf echo that views the echo as convolution of the tissue response and a component that represents the combined effect of the ultrasound impulse response and frequency dependent attenuation. Via low-pass filtering in the cepstrum domain, the combined ultrasonic contribution and attenuation term is extracted and used to estimate the center frequency. Furthermore, the tissue contribution is used to construct two new tissue characterization features. ROC analysis of 65 clinical ultrasound images of the breast indicates that the proposed features combined yield an area of 0.963.

A parametric imaging approach for the segmentation of ultrasound data

When an ultrasonic examination is performed, a segmentation tool would often be very useful, either for the detection of pathologies, the early diagnosis of cancer or the follow-up of the lesions. Such a tool must be both reliable and accurate. However, because of the relatively reduced quality of ultrasound images due to the speckled texture, the segmentation of ultrasound data is a difficult task. We have previously proposed to tackle the problem using a multiresolution Bayesian region-based algorithm. For computation time purposes, a multiresolution version has been implemented. In order to improve the quality of the segmentation, we propose to perform the segmentation not only from the envelope image but to combine more information about the properties of the tissues in the segmentation process. Several acoustical parameters have thus been computed, either directly from the images or from the radio-frequency (RF) signal. In a previous study, two parametric images were involved in the segmentation process. The parameter represented the integrated backscatter (IBS) and the mean central frequency (MCF), which is a measurement related to the attenuation of ultrasound waves in the media. In this study, parameters representative of the scattering conditions in the tissue are evaluated in the multiparametric segmentation process. They are extracted from the K-distribution (alpha,b) and the Nakagami distribution (m,Omega) and are related to the local density of scatterers (alpha,m), the size of the scatterers (b) and the backscattering properties of the medium (Omega). The acoustical features are calculated locally on a sliding window. This procedure allows to built parametric mapping representing the particular characteristics of the medium. To test the influence of the acoustical parameters in the segmentation process, a set of numerical phantoms has been computed using the Field software developed by J.A. Jensen. Each phantom consists in two regions with two different acoustical properties: the density of scatterers and the scattering amplitude. From both the simulated RF signals and envelope images, the parameters have been computed; their relevance to represent a particular characteristic of the medium is evaluated. The segmentation has been processed for each phantom. The ability of each parameter to improve the segmentation results is validated. A agar-gel phantom has also been created, in order to test the accuracy of the parameters in conditions closer to the in vivo ultrasound imaging. This phantom contains four inclusions with different concentrations of silica. A B&K ultrasound device provides the RF data. The quantification of the segmentation quality is based on the rate of correctly classified pixels and it has been computed for all the parameters either from the field images or the phantom images. The large improvement in the segmentation results obtained reveals that the multiparametric segmentation scheme proposed in this study can be a reliable tool for the processing of noisy ultrasound data.

Volumetric imaging with ultrasonic spiral CT

To examine the feasibility of implementing spiral computed tomography (CT) in ultrasonic imaging as a potential method for breast screening, an algorithm for x-ray spiral CT was applied to ultrasonic waves on a specially built ultrasonic tomographic system. Three-dimensional reconstructions of various phantoms were obtained. Spiral ultrasonic CT is feasible, and it may have clinical merit as a breast imaging method.

The direct estimation of sound speed using pulse-echo ultrasound

A method for the direct estimation of the longitudinal speed of sound in a medium is presented. This estimator derives the speed of sound through analysis of pulse-echo data received across a single transducer array following a single transmission, and is analogous to methods used in exploration seismology. A potential application of this estimator is the dynamic correction of beamforming errors in medical imaging that result from discrepancy between the assumed and actual biological tissue velocities. The theoretical basis of this estimator is described and its function demonstrated in phantom experiments. Using a wire target, sound-speed estimates in water, methanol, ethanol, and n-butanol are compared to published values. Sound-speed estimates in two speckle-generating phantoms are also compared to expected values. The mean relative errors of these estimates are all less than 0.4%, and under the most ideal experimental conditions are less than 0.1%. The relative errors of estimates based on independent regions of speckle-generating phantoms have a standard deviation on the order of 0.5%. Simulation results showing the relative significance of potential sources of estimate error are presented. The impact of sound-speed errors on imaging and the potential of this estimator for phase aberration correction and tissue characterization are also discussed.

Hybrid ultrasonic computed tomography

Ultrasonic computed tomography can provide valuable information on tissue properties. However, the large number of projections required to obtain a high-resolution image renders it impractical for routine clinical use. B-scan imaging, on the other hand is very rapid, but mainly provides information on tissue morphology. An algorithm which fuses information from a compound B-scan image and a limited view speed of sound (SOS) tomographic reconstruction of an object is presented here. The algorithm is iterative and is based on the two-dimensional Taylor series expansion. The algorithm diminishes artifacts caused by tomographic reconstruction from too few projections and produces an image which depicts both tissue morphology and acoustic properties (SOS). Consequently, quantitative images can be acquired in a much shorter time than required by conventional tomography. This method may potentially find application in ultrasonic breast screening.

Ultrasound tissue characterization of breast biopsy specimens: expanded study

Tissue classification by examining sets of ultrasound parameters is an elusive goal. We report analysis of measurements of ultrasound speed, attenuation and backscatter in the range 3 to 8 MHz in breast tissues at 37 C. Statistical discriminant analysis and neural net analysis were employed. Data were acquired from 24 biopsy and 7 mastectomy specimens. Best separation of the classes normal, benign, and malignant occurred in the 18 cases where two tissue classes were present in the same specimen and parameters were corrected for within-patient mean; then 85-90% of cases in test sets were correctly classified. Most errors comprised misclassified benign cases. The neural net was comparable to discriminant analysis and slightly superior in separating normal and malignant classes.

Design of an ultrasonic therapy system for breast cancer treatment

This paper describes the design of a novel ultrasonic therapy system dedicated to the breast cancer treatment and the theoretical investigation of the heating characteristics of the system. The applicator is a cylinder comprised of a stack of rings. Each ring has up to 48 transducers mounted on the inside of the ring and directed towards the centre. The transducers operate in one of two frequency bands (1.8-2.8 MHz and 4.3-40.8 MHz), arranged alternately in each ring. During treatment the patient is positioned in prone position, with the breast immersed in water and surrounded by this array. This design was modelled and optimized by 3-D simulations for a variety of treatment conditions. The simulated results demonstrate that the system has an excellent capability to achieve and maintain a temperature distribution (41.5-44 degrees C) in a quadrant to a whole breast. Initial experiments using a single ring of transducers has been performed to verify the power deposition calculation.