The interaction of macro- and microvascular function underlies brachial artery flow-mediated dilation in humans

Brachial artery flow-mediated dilation (BAFMD) is induced by hyperemic wall shear rate (WSR) following forearm ischemia. In older adults, there appears to be a reduced hyperemic WSR and altered stimulus-response relationship occurring at the brachial artery compared to young adults. However, it is unclear if an altered forearm microvascular response to ischemia influences brachial hyperemic WSR in older adults. We determined the association between brachial hyperemic WSR and forearm skeletal muscle oxygen saturation in young and older adults. Healthy young (n=17, 29±7 yrs) and older (n=32, 65±4 yrs) adults participated in the study. BAFMD by a multi-gate spectral Doppler system and forearm skeletal muscle oxygen saturation by near infrared spectroscopy were concurrently measured. Compared to the young, older adults showed reduced oxygen extraction kinetics [OE: 0.15 (0.12-0.17) vs 0.09 (0.05-0.12) %s-1] and magnitude (SO2deficit: 3810±1420 vs 2723±1240 %s) during ischemia, and oxygen re-saturation kinetics (SO2slope: 2.5±0.7 vs 1.7±0.7 %s-1) upon reperfusion (all p<0.05). When OE in the young and SO2slope in older adults were stratified by their median values, young adults with OE above median had greater hyperemic WSR parameters compared to those with OE below median (p<0.05), but SO2slope in older adults did not show clear differences in hyperemic WSR parameters between those with above/below median. This study demonstrates that, additionally to a reduced microvascular response to ischemia, there may be a possible dissociation of microvascular response to ischemia to brachial hyperemic WSR in older adults, which may result in a further impairment of BAFMD in this cohort.

High-Frame-Rate Volumetric Porcine Renal Vasculature Imaging

OBJECTIVE

The aim of this study was to assess the feasibility and imaging options of contrast-enhanced volumetric ultrasound kidney vasculature imaging in a porcine model using a prototype sparse spiral array.

METHODS

Transcutaneous freehand in vivo imaging of two healthy porcine kidneys was performed according to three protocols with different microbubble concentrations and transmission sequences. Combining high-frame-rate transmission sequences with our previously described spatial coherence beamformer, we determined the ability to produce detailed volumetric images of the vasculature. We also determined power, color and spectral Doppler, as well as super-resolved microvasculature in a volume. The results were compared against a clinical 2-D ultrasound machine.

RESULTS

Three-dimensional visualization of the kidney vasculature structure and blood flow was possible with our method. Good structural agreement was found between the visualized vasculature structure and the 2-D reference. Microvasculature patterns in the kidney cortex were visible with super-resolution processing. Blood flow velocity estimations were within a physiological range and pattern, also in agreement with the 2-D reference results.

CONCLUSION

Volumetric imaging of the kidney vasculature was possible using a prototype sparse spiral array. Reliable structural and temporal information could be extracted from these imaging results.

3-D Coherent Multi-Transducer Ultrasound Imaging with Sparse Spiral Arrays

Coherent multi-transducer ultrasound (CoMTUS) creates an extended effective aperture through the coherent combination of multiple arrays, which results in images with enhanced resolution, extended field-of-view, and higher sensitivity. The subwavelength localization accuracy of the multiple transducers required to coherently beamform the data is achieved by using the echoes backscattered from targeted points. In this study, CoMTUS is implemented and demonstrated for the first time in 3-D imaging using a pair of 256-element 2-D sparse spiral arrays, which keep the channel count low and limit the amount of data to be processed. The imaging performance of the method was investigated using both simulations and phantom tests. The feasibility of free-hand operation is also experimentally demonstrated. Results show that, in comparison to a single dense array system using the same total number of active elements, the proposed CoMTUS system improves spatial resolution (up to 10 times) in the direction where both arrays are aligned, contrast-to-noise-ratio (CNR, up to 46%), and generalized CNR (up to 15%). Overall, CoMTUS shows a narrower main lobe and higher contrast-to-noise ratio, which results in an increased dynamic range and better target detectability.

Design, Implementation, and Medical Applications of 2-D Ultrasound Sparse Arrays

An ultrasound sparse array consists of a sparse distribution of elements over a 2-D aperture. Such an array is typically characterized by a limited number of elements, which in most cases is compatible with the channel number of the available scanners. Sparse arrays represent an attractive alternative to full 2-D arrays that may require the control of thousands of elements through expensive application-specific integrated circuits (ASICs). However, their massive use is hindered by two main drawbacks: the possible beam profile deterioration, which may worsen the image contrast, and the limited signal-to-noise ratio (SNR), which may result too low for some applications. This article reviews the work done for three decades on 2-D ultrasound sparse arrays for medical applications. First, random, optimized, and deterministic design methods are reviewed together with their main influencing factors. Then, experimental 2-D sparse array implementations based on piezoelectric and capacitive micromachined ultrasonic transducer (CMUT) technologies are presented. Sample applications to 3-D (Doppler) imaging, super-resolution imaging, photo-acoustic imaging, and therapy are reported. The final sections discuss the main shortcomings associated with the use of sparse arrays, the related countermeasures, and the next steps envisaged in the development of innovative arrays.

Unfocused Field Analysis of a Density-Tapered Spiral Array for High-Volume-Rate 3-D Ultrasound Imaging

Spiral array transducers with a sparse 2-D aperture have demonstrated their potential in realizing 3-D ultrasound imaging with reduced data rates. Nevertheless, their feasibility in high-volume-rate imaging based on unfocused transmissions has yet to be established. From a metrology standpoint, it is essential to characterize the acoustic field of unfocused transmissions from spiral arrays not only to assess their safety but also to identify the root cause of imaging irregularities due to the array's sparse aperture. Here, we present a field profile analysis of unfocused transmissions from a density-tapered spiral array transducer (256 hexagonal elements, 220- [Formula: see text] element diameter, and 1-cm aperture diameter) through both simulations and hydrophone measurements. We investigated plane- and diverging-wave transmissions (five-cycle, 7.5-MHz pulses) from 0° to 10° steering for their beam intensity characteristics and wavefront arrival time profiles. Unfocused firings were also tested for B-mode imaging performance (ten compounded angles, -5° to 5° span). The array was found to produce unfocused transmissions with a peak negative pressure of 93.9 kPa at 2 cm depth. All transmissions steered up to 5° were free of secondary lobes within 12 dB of the main beam peak intensity. All wavefront arrival time profiles were found to closely match the expected profiles with maximum root-mean-squared errors of [Formula: see text] for plane wave (PW) and [Formula: see text] for diverging wave. The B-mode images showed good spatial resolution with a penetration depth of 22 mm in PW imaging. Overall, these results demonstrate that the density-tapered spiral array can facilitate unfocused transmissions below regulatory limits (mechanical index: 0.034; spatial-peak, pulse-average intensity: 0.298 W/cm2) and with suppressed secondary lobes while maintaining smooth wavefronts.

Sparse 2-D PZT-on-PCB Arrays With Density Tapering

Two-dimensional (2-D) arrays offer volumetric imaging capabilities without the need for probe translation or rotation. A sparse array with elements seeded in a tapering spiral pattern enables one-to-one connection to an ultrasound machine, thus allowing flexible transmission and reception strategies. To test the concept of sparse spiral array imaging, we have designed, realized, and characterized two prototype probes designed at 2.5-MHz low-frequency (LF) and 5-MHz high-frequency (HF) center frequencies. Both probes share the same electronic design, based on piezoelectric ceramics and rapid prototyping with printed circuit board substrates to wire the elements to external connectors. Different center frequencies were achieved by adjusting the piezoelectric layer thickness. The LF and HF prototype probes had 88% and 95% of working elements, producing peak pressures of 21 and 96 kPa/V when focused at 5 and 3 cm, respectively. The one-way -3-dB bandwidths were 26% and 32%. These results, together with experimental tests on tissue-mimicking phantoms, show that the probes are viable for volumetric imaging.

High-Frame-Rate Speckle Tracking for Echocardiographic Stress Testing

Stress echocardiography helps to diagnose cardiac diseases that cannot easily be detected or do not even manifest at rest. In clinical practice, assessment of the stress test is usually performed visually and, therefore, in a qualitative and subjective way. Although speckle tracking echocardiography (STE) has been proposed for the quantification of function during stress, its time resolution is inadequate at high heart rates. Recently, high-frame-rate (HFR) imaging approaches have been proposed together with dedicated STE algorithms capable of handling small interframe displacements. The aim of this study was to determine if HFR STE is effective in assessing strain and strain rate parameters during echocardiographic stress testing. Specifically, stress echocardiography, at four different workload intensities, was performed in 25 healthy volunteers. At each stress level, HFR images from the apical four-chamber view were recorded using the ULA-OP 256 experimental scanner. Then, the myocardium was tracked with HFR STE, and strain and strain rate biomarkers were extracted to further analyze systolic and diastolic (early and late) peaks, as well as a short-lived isovolumic relaxation peak during stress testing. The global systolic strain response was monophasic, revealing a significant (p < 0.001) increase at low stress but then reaching a plateau. In contrast, all strain rate indices linearly increased (p < 0.001) with increasing stress level. These findings are in line with those reported using tissue Doppler imaging and, thus, indicate that HFR STE can be a useful tool in assessing cardiac function during stress echocardiography.

Spatial Coherence Beamforming With Multi-Line Transmission to Enhance the Contrast of Coherent Structures in Ultrasound Images Degraded by Acoustic Clutter

This work demonstrates that the combination of multi-line transmission (MLT) and short-lag spatial coherence (SLSC) imaging improves the contrast of highly coherent structures within soft tissues when compared to both traditional SLSC imaging and conventional delay and sum (DAS) beamforming. Experimental tests with small (i.e., [Formula: see text]-3 mm) targets embedded in homogeneous and heterogeneous backgrounds were conducted. DAS or SLSC images were reconstructed when implementing MLT with varying numbers of simultaneously transmitted beams. In images degraded by acoustic clutter, MLT SLSC achieved up to 34.1 dB better target contrast and up to 16 times higher frame rates when compared to the more conventional single-line transmission SLSC images, with lateral resolution improvements as large as 38.2%. MLT SLSC thus represents a promising technique for clinical applications in which ultrasound visualization of highly coherent targets is required (e.g., breast microcalcifications, kidney stones, and percutaneous biopsy needle tracking) and would otherwise be challenging due to the strong presence of acoustic clutter.

Speckle tracking during stress echocardiography using high frame rate imaging

Background

As many cardiac diseases do not lead to symptoms under resting conditions, subjecting the patient to a stress (e.g. exercise) test is clinical routine to reveal disease. Quantification of cardiac function using speckle tracking echocardiography (STE) during such stress test remains a challenge not only as overall image quality typically drops but also as the heart rate increases which results in an unfavourable heart-rate-to-frame-rate ratio as required for robust tracking. Moreover, conventional STE runs at relatively low frame rate thereby under-resolving peak strain rate (SR) values – which is particularly true at high heart rates – while this biomarker has been shown to better disclose stress-induced disease than strain using Tissue Doppler Imaging (TDI)-based strain methodologies.

Purpose

The aim of this study was therefore to test whether HFR STE could reveal the strain / SR response described previously in the TDI literature.

Methods

Stress echocardiography was performed in 25 healthy volunteers at four different stress levels (baseline, 25%, 50% and 66% of maximum workload) using a supine bike. Apical 4-chamber views were recorded using the ULA-OP 256 experimental scanner running a HFR sequence based on the compounding of 6 diverging wave transmits to achieve a frame rate of 833Hz. A myocardial contour was manually drawn on the reconstructed images and tracked during the cardiac cycle by a custom-made 2D HFR STE algorithm (DOI: 10.1109/TUFFC.2020.2985451). Then, strain and strain rate curves were computed from which systolic (S) and diastolic (early (E) and late (A)) peak values, as well as the short-lived isovolumic relaxation peak (IVR) were extracted. Finally, these values were compared amongst the different stress levels using a single factor ANOVA.

Results

Some datasets had to be discarded as the contour was not properly tracked at a visual assessment of an expert cardiologist. Tracking was feasible in 92%, 98%, 80% and 64% of cases, for baseline, 25%, 50% and 66% of maximum workload, respectively. The decreasing feasibility with exercise level is in line with what is seen clinically, as volunteers' breathing is faster and heavier with increasing exercise level making the imaging more challenging. The extracted strain and SR curves showed a physiological pattern (Fig. 1a). As shown in Fig. 1b, the global systolic strain response was biphasic, showing a significant increase at low stress level but then reaching a plateau. In contrast, all SR indices linearly increased at each stress level.

Conclusion

Strain rate clinical markers extracted with HFR STE are concordant with what was reported in TDI literature. These findings show that HFR STE allows to assess cardiac function adequately during stress echocardiography.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): FWO - Research Foundation Flanders

High frame rate speckle tracking echocardiography to assess diastolic function

Background

Left ventricular (LV) strain rate (SR) during isovolumic relaxation (SRIVR) and early diastolic filling (SRe) has previously been shown to correlate with the invasive gold standard for LV diastolic function (i.e. the time constant of LV pressure decay tau). However, the translation of these biomarkers to the clinic has been hampered by technical limitations. Indeed, conventional speckle tracking (STE) is limited by its temporal resolution, whereas tissue Doppler imaging (TDI) is angle-dependent, labor-intensive and thus rarely used clinically nowadays.

Purpose

The aim of this study was to show that these limitations could be overcome by using a recently proposed STE algorithm operating on high frame rate (HFR) imaging data.

Methods

37 subjects (age: 64±12, 81% male) were included in the study; 16 had cardiac amyloidosis, 12 were undergoing clinically indicated left and/or right heart cardiac catheterization and 9 were healthy volunteers. Since the sequence of left ventricular activation and thus the repolarization process (i.e. relaxation) starts at mid septum, we measured SRIVR and SRe in the mid septal segment in an apical 4 chamber view using a commercially available clinical system with: (1) TDI (frame rate (FR) ∼142 Hz); (2) STE (FR ∼65 Hz). Moreover, subjects were scanned with HD-PULSE, an experimental high frame ultrasound scanner (FR ∼915 Hz) and then a manually placed contour was tracked during the cardiac cycle by a custom-made 2D HFR STE algorithm, to compute and extract SRIVR and SRe from the mid septum. Since TDI is considered the reference method to assess SR, conventional as well as HFR STE values were correlated against the TDI SR values.

Results

In 3 subjects, SRIVR could not be reliably assessed with the clinical STE approach, which we attributed to the relatively low temporal resolution of the images; all other measurements could be made in all subjects. For both biomarkers, HFR STE values correlated better with the TDI reference measurements than the clinical STE estimates (Fig.1). The latter estimates showed a systematic underestimation (bias −0.19 1/s (p&lt;0.01) and −0.46 1/s (p&lt;0.01) for SRIVR and SRe respectively) while no significant bias was observed for the HFR STE values. Similarly, the limits of agreement of the HFR STE values were narrower (−0.45 to +0.54 1/s and −0.94 to +0.86 1/s) than those of the clinical STE measurements (−0.85 to +0.48 1/s and −1.32 to +0.41 1/s).

Conclusions

These results show that HFR STE offers a reliable way to assess novel biomarkers of diastolic function in a user-friendly manner and can therefore facilitate their incorporation to the clinical practice.

Funding Acknowledgement

Type of funding sources: None.

High Frame Rate Volumetric Imaging of Microbubbles Using a Sparse Array and Spatial Coherence Beamforming

Volumetric ultrasound imaging of blood flow with microbubbles enables a more complete visualization of the microvasculature. Sparse arrays are ideal candidates to perform volumetric imaging at reduced manufacturing complexity and cable count. However, due to the small number of transducer elements, sparse arrays often come with high clutter levels, especially when wide beams are transmitted to increase the frame rate. In this study, we demonstrate with a prototype sparse array probe and a diverging wave transmission strategy, that a uniform transmission field can be achieved. With the implementation of a spatial coherence beamformer, the background clutter signal can be effectively suppressed, leading to a signal to background ratio improvement of 25 dB. With this approach, we demonstrate the volumetric visualization of single microbubbles in a tissue-mimicking phantom as well as vasculature mapping in a live chicken embryo chorioallantoic membrane.

On the Depth-Dependent Accuracy of Plane-Wave-Based Vector Velocity Measurements With Linear Arrays

High-frame-rate vector Doppler methods are used to measure blood velocities over large 2-D regions, but their accuracy is often estimated over a short range of depths. This article thoroughly examines the dependence of velocity measurement accuracy on the target position. Simulations were carried out on flat and parabolic flow profiles, for different Doppler angles, and considering a 2-D vector flow imaging (2-D VFI) method based on plane wave transmission and speckle tracking. The results were also compared with those obtained by the reference spectral Doppler (SD) method. Although, as expected, the bias and standard deviation generally tend to worsen at increasing depths, the measurements also show the following. First, the errors are much lower for the flat profile (from ≈ -4 ± 3% at 20 mm to ≈ -17 ± 4% at 100 mm) than for the parabolic profile (from ≈ -4 ± 3% to ≈ -38 ±%). Second, only part of the relative estimation error is related to the inherent low resolution of the 2-D VFI method. For example, even for SD, the error bias increases (on average) from -0.7% (20 mm) to -17% (60 mm) up to -26% (100 mm). Third, conversely, the beam divergence associated with the linear array acoustic lens was found to have a great impact on the velocity measurements. By simply removing such lens, the average bias for 2-D VFI at 60 and 100 mm dropped down to -9.4% and -19.4%, respectively. In conclusion, the results indicate that the transmission beam broadening on the elevation plane, which is not limited by reception dynamic focusing, is the main cause of velocity underestimation in the presence of high spatial gradients.

Architecture for an Ultrasound Advanced Open Platform With an Arbitrary Number of Independent Channels

Ultrasound open platforms are programmable and flexible tools for the development and test of novel methods. In most cases, they embed the electronics for the independent control of (maximum) 256 probe elements. However, a higher number of channels is needed for the control of 2-D array probes. This paper presents a system architecture that, through the hardware and software synchronization of multiple ULA-OP 256 scanners, may implement advanced open platforms with an arbitrary number of channels. The proposed solution needs a single personal computer, maintains real-time features, and preserves portability. A prototype demonstrator, composed of two ULA-OP 256 scanners connected to 512 elements of a matrix array, was implemented and tested according to different channel configurations. Experiments performed under MATLAB control confirmed that by doubling the number of elements (from 256 to 512) the signal-to-noise and contrast ratios improve by 9 dB and 3 dB, respectively. Furthermore, as a full 512-channel scanner, the demonstrator can produce real-time B-mode images at 18 Hz, high enough for probe positioning during acquisitions. Also, the demonstrator permitted the implementation of a new high frame rate, bi-plane, triplex modality. All probe elements are excited to simultaneously produce two planar, perpendicular diverging waves. Each scanner independently processes the echoes received by the 256 connected elements to beamform 1300 frames per second. For each insonified plane, good quality morphological (B-mode), qualitative (color flow-), and quantitative (spectral-) Doppler images are finally shown in real-time by a dedicated interface.

Real-Time 3-D Spectral Doppler Analysis With a Sparse Spiral Array

2-D sparse arrays may push the development of low-cost 3-D systems, not needing to control thousands of elements by expensive application-specific integrated circuits (ASICs). However, there is still some concern about their suitability in applications, such as Doppler investigation, which inherently involve poor signal-to-noise ratios (SNRs). In this article, a novel real-time 3-D pulsed-wave (PW) Doppler system, based on a 256-element 2-D spiral array, is presented. Coded transmission (TX) and matched filtering were implemented to improve the system SNR. Standard sonograms as well as multigate spectral Doppler (MSD) profiles, along lines that can be arbitrarily located in different planes, are presented. The performance of the system was assessed quantitatively on experimental data obtained from a straight tube flow phantom. An SNR increase of 11.4 dB was measured by transmitting linear chirps instead of standard sinusoidal bursts. For a qualitative assessment of the system performance in more realistic conditions, an anthropomorphic phantom of the carotid arteries was used. Finally, real-time B-mode and MSD images were obtained from healthy volunteers.

In Vivo Comparison of Multiline Transmission and Diverging Wave Imaging for High-Frame-Rate Speckle-Tracking Echocardiography

High-frame-rate (HFR) speckle-tracking echocardiography (STE) assesses myocardial function by quantifying motion and deformation at high temporal resolution. Among the proposed HFR techniques, multiline transmission (MLT) and diverging wave (DW) imaging have been used in this context both being characterized by specific advantages and disadvantages. Therefore, in this article, we directly contrast both approaches in an in vivo setting while operating at the same frame rate (FR). First, images were recorded at baseline (resting condition) from healthy volunteers and patients. Next, additional acquisitions during stress echocardiography were performed on volunteers. Each scan was contoured and processed by a previously proposed 2-D HFR STE algorithm based on cross correlation. Then, strain curves and their end-systolic (ES) values were extracted for all myocardial segments for further statistical analysis. The baseline acquisitions did not reveal differences in estimated strain between the acquisition modes ( ); myocardial segments ( ); or an interaction between imaging mode and depth ( ). Similarly, during stress testing, no difference ( p = 0.7 ) was observed for the two scan sequences, stress levels or an interaction sequence-stress level ( p = 0.94 ). Overall, our findings show that MLT and DW compoundings give comparable HFR STE strain values and that the choice for using one method or the other may thus rather be based on other factors, for example, system requirements or computational cost.

Impact of Aperture, Depth, and Acoustic Clutter on the Performance of Coherent Multi-Transducer Ultrasound Imaging

Transducers with a larger aperture size are desirable in ultrasound imaging to improve resolution and image quality. A coherent multi-transducer ultrasound imaging system (CoMTUS) enables an extended effective aperture through the coherent combination of multiple transducers. In this study, the discontinuous extended aperture created by CoMTUS and its performance for deep imaging and through layered media are investigated by both simulations and experiments. Typical image quality metrics—resolution, contrast and contrast-to-noise ratio—are evaluated and compared with a standard single probe imaging system. Results suggest that the image performance of CoMTUS depends on the relative spatial location of the arrays. The resulting effective aperture significantly improves resolution, while the separation between the arrays may degrade contrast. For a limited gap in the effective aperture (less than a few centimetres), CoMTUS provides benefits to image quality compared to the standard single probe imaging system. Overall, CoMTUS shows higher sensitivity and reduced loss of resolution with imaging depth. In general, CoMTUS imaging performance was unaffected when imaging through a layered medium with different speed of sound values and resolution improved up to 80% at large imaging depths.

A Novel 2-D Speckle Tracking Method for High-Frame-Rate Echocardiography

Speckle tracking echocardiography (STE) is a clinical tool to noninvasively assess regional myocardial function through the quantification of regional motion and deformation. Even if the time resolution of STE can be improved by high-frame-rate (HFR) imaging, dedicated HFR STE algorithms have to be developed to detect very small interframe motions. Therefore, in this article, we propose a novel 2-D STE method, purposely developed for HFR echocardiography. The 2-D motion estimator consists of a two-step algorithm based on the 1-D cross correlations to separately estimate the axial and lateral displacements. The method was first optimized and validated on simulated data giving an accuracy of ~3.3% and ~10.5% for the axial and lateral estimates, respectively. Then, it was preliminarily tested in vivo on ten healthy volunteers showing its clinical applicability and feasibility. Moreover, the extracted clinical markers were in the same range as those reported in the literature. Also, the estimated peak global longitudinal strain was compared with that measured with a clinical scanner showing good correlation and negligible differences (-20.94% versus -20.31%, p -value = 0.44). In conclusion, a novel algorithm for STE was developed: the radio frequency (RF) signals were preferred for the axial motion estimation, while envelope data were preferred for the lateral motion. Furthermore, using 2-D kernels, even for 1-D cross correlation, makes the method less sensitive to noise.

High-Frame-Rate Color Doppler Echocardiography: A Quantitative Comparison of Different Approaches

Ultrasound color Doppler imaging (CDI) provides a map of the axial blood flow velocities in a 2-D/3-D region of interest. While CDI is clinically effective for a qualitative analysis of abnormal blood flows, e.g., for valvular disease in cardiology, it is in limited use for quantitative measures, mainly hampered by low frame rate and measurement bias. These limitations can be reduced by different approaches toward high-frame-rate (HFR) imaging at the expense of reduced image quality and penetration depth. The aim of this study was to compare the impact of different HFR sequences on CDI quantitatively. Different cardiac scan sequences, including diverging waves and multiline transmission, were designed, implemented on a research system, and compared in terms of patient safety parameters, image quality, and penetration depth. Furthermore, in vivo images were acquired and compared for healthy volunteers. Results showed that the HFR techniques spread artifacts on larger areas than the standard single-line scans (> +50%). In addition, due to patient safety limitations, they reduce the penetration depth up to -5 cm. On the other hand, the HFR techniques provide comparable velocity estimates (relative difference <6%) and enhance the time resolution of the color Doppler images, achieving frame rates up to 625 Hz in continuous acquisition.

A Comparison of Coherence-Based Beamforming Techniques in High-Frame-Rate Ultrasound Imaging With Multi-Line Transmission

One of the current challenges in ultrasound imaging is achieving higher frame rates, particularly in cardiac applications, where tracking the heart motion and other rapid events can provide potential valuable diagnostic information. The main drawback of ultrasound high-frame-rate strategies is that usually they partly sacrifice image quality in order to speed up the acquisition time. In particular, multi-line transmission (MLT), which consists in transmitting multiple ultrasound beams simultaneously in different directions, has been proven able to improve frame rates in echocardiography, unfortunately generating artifacts due to inter-beam crosstalk interferences. This work investigates the possibility to effectively suppress crosstalk artifacts in MLT while improving image quality by applying beamforming techniques based on backscattered signals spatial coherence. Several coherence-based algorithms (i.e., short-lag filtered-delay multiply and sum beamforming, coherence and generalized coherence factor, phase and sign coherence, and nonlinear beamforming with p th root compression) are implemented and compared, and their performance trends are evaluated when varying their design parameters. Indeed, experimental results of phantom and in vivo cardiac acquisitions demonstrate that this class of algorithms can provide significant benefits compared with delay and sum, well-suppressing artifacts (up to 48.5-dB lower crosstalk), and increasing image resolution (by up to 46.3%) and contrast (by up to 30 dB in terms of contrast ratio and 12.6% for generalized contrast-to-noise ratio) at the same time.

3-D Super-Resolution Ultrasound Imaging With a 2-D Sparse Array

High-frame-rate 3-D ultrasound imaging technology combined with super-resolution processing method can visualize 3-D microvascular structures by overcoming the diffraction-limited resolution in every spatial direction. However, 3-D super-resolution ultrasound imaging using a full 2-D array requires a system with a large number of independent channels, the design of which might be impractical due to the high cost, complexity, and volume of data produced. In this study, a 2-D sparse array was designed and fabricated with 512 elements chosen from a density-tapered 2-D spiral layout. High-frame-rate volumetric imaging was performed using two synchronized ULA-OP 256 research scanners. Volumetric images were constructed by coherently compounding nine-angle plane waves acquired at a pulse repetition frequency of 4500 Hz. Localization-based 3-D super-resolution images of two touching subwavelength tubes were generated from 6000 volumes acquired in 12 s. Finally, this work demonstrates the feasibility of 3-D super-resolution imaging and super-resolved velocity mapping using a customized 2-D sparse array transducer.

Spectral Doppler Measurements With 2-D Sparse Arrays

The 2-D sparse arrays, in which a few hundreds of elements are distributed on the probe surface according to an optimization procedure, represent an alternative to full 2-D arrays, including thousands of elements usually organized in a grid. Sparse arrays have already been used in B-mode imaging tests, but their application to Doppler investigations has not been reported yet. Since the sparsity of the elements influences the acoustic field, a corresponding influence on the mean frequency (Fm), bandwidth (BW), and signal-to-noise ratio (SNR) of the Doppler spectra is expected. This article aims to assess, by simulations and experiments, to what extent the use of a sparse rather than a full gridded 2-D array has an impact on spectral Doppler measurements. Parabolic flows were investigated by a 3 MHz, 1024-element gridded array and by a sparse array; the latter was obtained by properly selecting a subgroup of 256 elements from the full array. Simulations show that the mean Doppler frequency does not change between the sparse and the full array while there are significant differences on the BW (average reduction of 17.2% for the sparse array, due to different apertures of the two probes) and on the signal power (Ps) (22 dB, due to the different number of active elements). These results are confirmed by flow phantom experiments, which also highlight that the most critical difference between sparse and full gridded array in Doppler measurements is in terms of SNR (-16.8 dB).

High-Frame-Rate Tri-Plane Echocardiography With Spiral Arrays: From Simulation to Real-Time Implementation

Major cardiovascular diseases (CVDs) are associated with (regional) dysfunction of the left ventricle. Despite the 3-D nature of the heart and its dynamics, the assessment of myocardial function is still largely based on 2-D ultrasound imaging, thereby making diagnosis heavily susceptible to the operator's expertise. Unfortunately, to date, 3-D echocardiography cannot provide adequate spatiotemporal resolution in real-time. Hence, tri-plane imaging has been introduced as a compromise between 2-D and true volumetric ultrasound imaging. However, tri-plane imaging typically requires high-end ultrasound systems equipped with fully populated matrix array probes embedded with expensive and little flexible electronics for two-stage beamforming. This article presents an advanced ultrasound system for real-time, high frame rate (HFR), and tri-plane echocardiography based on low element count sparse arrays, i.e., the so-called spiral arrays. The system was simulated, experimentally validated, and implemented for real-time operation on the ULA-OP 256 system. Five different array configurations were tested together with four different scan sequences, including multi-line and planar diverging wave transmission. In particular, the former can be exploited to achieve, in tri-plane imaging, the same temporal resolution currently used in clinical 2-D echocardiography, at the expenses of contrast (-3.5 dB) and signal-to-noise ratio (SNR) (-8.7 dB). On the other hand, the transmission of planar diverging waves boosts the frame rate up to 250 Hz, but further compromises contrast (-10.5 dB), SNR (-9.7 dB), and lateral resolution (+46%). In conclusion, despite an unavoidable loss in image quality and sensitivity due to the limited number of elements, HFR tri-plane imaging with spiral arrays is shown to be feasible in real-time and may enable real-time functional analysis of all left ventricular segments of the heart.

Arterial wall shear rate response to reactive hyperaemia is markedly different between young and older humans

KEY POINTS

The vasodilatory response to reactive hyperaemia is impaired with advancing age, but it is unclear whether this is because of an altered wall shear rate (WSR) stimulus or an altered flow-mediated dilatation (FMD) response. Using new technology that allows detailed WSR measurement, we assessed the WSR-FMD response in healthy older people. Our data show that older people have a markedly altered and diminished WSR response to reactive hyperaemia compared to young people, but reduced WSR alone does not fully explain reduced FMD. In young people, WSR appears to be coupled to FMD but, by age ∼65 years, the arterial vasodilatory response has begun to uncouple from the WSR stimulus. These findings point to the importance and utility of comprehensively characterizing the WSR-FMD response when using reactive hyperaemia to assess vascular function, as well as giving new insight into the age-related alteration in vascular function.

ABSTRACT

The vasodilatory response to reactive hyperaemia is impaired with age, but it is unknown whether this is because of an altered wall shear rate (WSR) stimulus or an altered flow-mediated dilatation (FMD) response to the WSR stimulus. Inherent difficulties in measuring blood flow velocity close to the arterial wall have prevented detailed assessment of the WSR-FMD response. Using an enhanced multigate spectral Doppler ultrasound system (ultrasound advanced open platform), we aimed to produce new data on the WSR-FMD relationship in healthy older adults. Sixty healthy people, comprising 28 young (27.5 ± 5.5 years) and 32 older (64.9 ± 3.7 years) individuals, underwent FMD assessment. Raw data were post-processed using custom-designed software to obtain WSR and diameter parameters. The data revealed that older people have a much altered and diminished WSR response to reactive hyperaemia compared to younger people [e.g. WSR peak: 622 (571-673) vs. 443 (396-491) 1/s in young and older respectively; P < 0.05]. However, reduced WSR alone does not appear to fully explain the reduced FMD response in older people because associations between WSR and FMD were few and weak. This was in contrast to young adults, where associations were strong. We conclude that WSR during FMD is much altered and diminished in older people, and there appears to be an 'uncoupling' of WSR from FMD in older people that may reflect a loss of precision in the reactive hyperaemia stimulus-response relationship. These findings also point to the importance and utility of comprehensively characterizing the WSR-FMD response when using reactive hyperaemia to assess vascular function.

Continuous Simultaneous Recording of Brachial Artery Distension and Wall Shear Rate: A New Boost for Flow-Mediated Vasodilation

Vascular ultrasound has been extensively applied in the clinical setting to noninvasively assess the endothelial function by means of the so-called brachial artery flow mediated dilation (FMD). Despite the usefulness in large-scale epidemiological studies, this approach has revealed some pitfalls for assessing vascular physiology and health in individual subjects. Mainly, a reliable FMD examination should be based on the simultaneous and reliable measurement of both the stimulus, i.e., the wall shear rate (WSR), and the response, i.e., the diameter change. However, multiple technical, practical, and methodological challenges must be faced to meet this goal. In this work, we present the technical developments needed to implement a system to enable the extensive and reliable clinical ultrasound FMD examination. It integrates both a hardware part, i.e., an upgraded version of the ultrasound advanced open platform (ULA-OP), and a software part, i.e., a signal processing and data analysis platform. The system was applied for a two-center pilot clinical study on 35 young and healthy volunteers. Therefore, we present here the results of a statistical analysis on magnitude, time-course, and kinetic parameters of WSR and diameter trends that allowed us to accurately explore the vasodilatory response to the dynamic WSR changes. Our observations demonstrate that a direct and accurate estimation of WSR stimulus by multigate spectral Doppler allows understanding brachial artery vasodilatory response to reactive hyperemia. Drawing inferences on WSR stimulus from the diameter response along with an inaccurate estimation of WSR may cause further uncertainties for the accurate interpretation of the FMD response.

Weighting the Passive Acoustic Mapping Technique With the Phase Coherence Factor for Passive Ultrasound Imaging of Ultrasound-Induced Cavitation

Ultrasound (US) cavitation is currently being explored for low-invasive therapy techniques applied to a wide panel of pathologies. Because of the random behavior of cavitation, a real-time spatial monitoring system may be required. For this purpose, the US passive imaging techniques have been recently investigated. In particular, the passive acoustic mapping (PAM) beamforming method enables the reconstruction of cavitation activity maps by beamforming acoustic signals passively recorded by an array transducer. In this paper, an optimized version of PAM, PAM weighted with a phase coherence factor (PAM-PCF), is considered. A general validation process is developed including simulations on a point source and experiments on a wire. Furthermore, using a focused regulated US-induced cavitation generator, reproducible cavitation experiments are conducted in water and in agar gel. The spatial behavior of a bubble cavitation cloud is determined using the PAM-PCF beamforming method to localize the focal cavitation point in two perpendicular imaging planes.

Real-Time High-Frame-Rate Cardiac B-Mode and Tissue Doppler Imaging Based on Multiline Transmission and Multiline Acquisition

Cardiovascular diseases, the leading cause of death in the world, are often associated with the dysfunction of the left ventricle. Even if, in clinical practice, the myocardial function is often assessed through visual wall motion scoring on B-mode images, quantitative techniques have been introduced, e.g., ultrasound tissue Doppler imaging (TDI). However, this technique suffers from the limited frame rate of currently available imaging techniques that needs to be balanced with the field of view. High-frame-rate (HFR) cardiac imaging has been recently tested off-line by simultaneously transmitting multiple focused beams into different directions and acquiring raw channel data into a PC. Several image lines were then reconstructed from the echoes of each transmission (TX) event. The same approach has been used to increase the TDI frame rate without restricting the field of view. This paper demonstrates the real-time feasibility of multiline TX and acquisition methods for both HFR cardiac B-mode and TDI. These approaches have been implemented on the ULA-OP 256 research scanner, by taking care that the related resources were optimally exploited for these new applications. The obtainable performance in terms of image quality and frame rate has also been investigated. Experiments performed with a 128-element phased array probe show, for the first time, that real-time B-mode imaging is feasible at up to 1150 Hz without significant reduction in image quality or field of view. The implementation of a real-time TDI algorithm allowed obtaining TDI images with a frame rate of 288 Hz for a 90°-wide field of view. Finally, in vivo examples demonstrate the feasibility and the suitability of the method in clinical studies.

Experimental evaluation of ultrasound higher-order harmonic imaging with Filtered-Delay Multiply And Sum (F-DMAS) non-linear beamforming

Tissue Harmonic Imaging (THI) mode is currently one of the preferred choices by the clinicians for its ability to provide enhanced ultrasound images, thanks to the use of the second harmonic component of backscattered echoes. This paper aims at investigating whether the combination of THI with Filtered-Delay Multiply And Sum (F-DMAS) beamforming can provide further improvements in image quality. F-DMAS is a new non-linear beamformer, which, similarly to THI, is based on the use of the second harmonics of beamformed signals and is known to increase image contrast resolution and noise rejection. Thus, we have first compared the images obtained by using F-DMAS and the standard Delay And Sum (DAS) beamformers when only the second harmonics of the received signals was selected. Moreover, possible improvements brought about by other harmonic components generated by the combined use of the fundamental plus second harmonics and F-DMAS beamforming have been explored. Experimental results demonstrate that, as compared to standard harmonic imaging with DAS, THI and F-DMAS can be joined to improve the -20 dB lateral resolution up to 1 mm, the contrast ratio up to 12 dB on a cyst-phantom and up to 9 dB on in vivo images.

Real-Time Blood Velocity Vector Measurement Over a 2-D Region

Quantitative blood velocity measurements, as currently implemented in commercial ultrasound scanners, are based on pulsed-wave (PW) spectral Doppler and are limited to detect the axial component of the velocity in a single sample volume. On the other hand, vector Doppler methods produce angle-independent estimates by, e.g., combining the frequency shifts measured from different directions. Moreover, thanks to the transmission of plane waves, the investigation of a 2-D region is possible with high temporal resolution, but, unfortunately, the clinical use of these methods is hampered by the massive calculation power required for their real-time execution. In this paper, we present a novel approach based on the transmission of plane waves and the simultaneous reception of echoes from 16 distinct subapertures of a linear array probe, which produces eight lines distributed over a 2-D region. The method was implemented on the ULAO-OP 256 research scanner and tested both in phantom and in vivo. A continuous real-time refresh rate of 36 Hz was achieved in duplex combination with a standard B-mode at pulse repetition frequency of 8 kHz. Accuracies of -11% on velocity and of 2°on angle measurements have been obtained in phantom experiments. Accompanying movies show how the method improves the quantitative measurements of blood velocities and details the flow configurations in the carotid artery of a volunteer.

Multi Line Transmit Beamforming Combined With Adaptive Apodization

Increased frame rate is of high importance to cardiac diagnostic imaging as it enables examination of fast events during the cardiac cycle and improved quantitative analysis, such as speckle tracking. Multi-line transmission (MLT) is one of the methods proposed for this purpose. In contrast to the single-line transmission (SLT), where one focused beam is sent in each direction, MLT beams are simultaneously transmitted and focused in several (2,4,6..) directions improving the framerate accordingly. The simultaneous transmission is known to cause cross-talk artifacts due to the interference between the main-lobes and the side-lobes of the transmitted and received beams. Usually, the artifacts are attenuated using a Tukey window apodization, but the lateral resolution is degraded. Several other methods, such as minimum variance beamforming and filtered delay multiply and sum beamforming were proposed to deal with these artifacts.The assumption examined in this study is that a receive apodization can be chosen adaptively from a number of apodization windows in order to provide better artifact rejection and to increase the spatial resolution. The entire study was performed on experimental MLT dataset including wire and tissue mimicking phantoms, as well as in vivo cardiac data. The results demonstrate that application of a predefined apodization bank outperforms Tukey windowing alone, in terms of both resolution and receive crosstalk artifact rejection. Moreover, the achieved spatial resolution is superior to the non-apodized SLT, as measured from wire phantoms. The proposed method can also be combined with wider transmit beams, suitable for multi line acquisition.

An Experimental Protocol for Assessing the Performance of New Ultrasound Probes Based on CMUT Technology in Application to Brain Imaging

The possibility to perform an early and repeatable assessment of imaging performance is fundamental in the design and development process of new ultrasound (US) probes. Particularly, a more realistic analysis with application-specific imaging targets can be extremely valuable to assess the expected performance of US probes in their potential clinical field of application. The experimental protocol presented in this work was purposely designed to provide an application-specific assessment procedure for newly-developed US probe prototypes based on Capacitive Micromachined Ultrasonic Transducer (CMUT) technology in relation to brain imaging. The protocol combines the use of a bovine brain fixed in formalin as the imaging target, which ensures both realism and repeatability of the described procedures, and of neuronavigation techniques borrowed from neurosurgery. The US probe is in fact connected to a motion tracking system which acquires position data and enables the superposition of US images to reference Magnetic Resonance (MR) images of the brain. This provides a means for human experts to perform a visual qualitative assessment of the US probe imaging performance and to compare acquisitions made with different probes. Moreover, the protocol relies on the use of a complete and open research and development system for US image acquisition, i.e. the Ultrasound Advanced Open Platform (ULA-OP) scanner. The manuscript describes in detail the instruments and procedures involved in the protocol, in particular for the calibration, image acquisition and registration of US and MR images. The obtained results prove the effectiveness of the overall protocol presented, which is entirely open (within the limits of the instrumentation involved), repeatable, and covers the entire set of acquisition and processing activities for US images.

Brachial artery vasodilatory response and wall shear rate determined by multigate Doppler in a healthy young cohort

Wall shear rate (WSR) is an important stimulus for the brachial artery flow-mediated dilation (FMD) response. However, WSR estimation near the arterial wall by conventional Doppler is inherently difficult. To overcome this limitation, we utilized multigate Doppler to accurately determine the WSR stimulus near the vessel wall simultaneously with the FMD response using an integrated FMD system [Ultrasound Advanced Open Platform (ULA-OP)]. Using the system, we aimed to perform a detailed analysis of WSR-FMD response and establish novel WSR parameters in a healthy young population. Data from 33 young healthy individuals (27.5 ± 4.9 yr, 19 females) were analyzed. FMD was assessed with reactive hyperemia using ULA-OP. All acquired raw data were postprocessed using custom-designed software to obtain WSR and diameter parameters. The acquired velocity data revealed that nonparabolic flow profiles within the cardiac cycle and under different flow states, with heterogeneity between participants. We also identified seven WSR magnitude and four WSR time-course parameters. Among them, WSR area under the curve until its return to baseline was the strongest predictor of the absolute ( R² = 0.25) and percent ( R² = 0.31) diameter changes in response to reactive hyperemia. For the first time, we identified mono- and biphasic WSR stimulus patterns within our cohort that produced different magnitudes of FMD response [absolute diameter change: 0.24 ± 0.10 mm (monophasic) vs. 0.17 ± 0.09 mm (biphasic), P < 0.05]. We concluded that accurate and detailed measurement of the WSR stimulus is important to comprehensively understand the FMD response and that this advance in current FMD technology could be important to better understand vascular physiology and pathology. NEW & NOTEWORTHY An estimation of wall shear rate (WSR) near the arterial wall by conventional Doppler ultrasound is inherently difficult. Using a recently developed integrated flow-mediated dilation ultrasound system, we were able to accurately estimate WSR near the wall and identified a number of novel WSR variables that may prove to be useful in the measurement of endothelial function, an important biomarker of vascular physiology and disease.

Architecture of an Ultrasound System for Continuous Real-Time High Frame Rate Imaging

High frame rate (HFR) imaging methods based on the transmission of defocused or plane waves rather than focused beams are increasingly popular. However, the production of HFR images poses severe requirements both in the transmission and the reception sections of ultrasound scanners. In particular, major technical difficulties arise if the images must be continuously produced in real-time, i.e., without any acquisition interruption nor loss of data. This paper presents the implementation of the real-time HFR-compounded imaging application in the ULA-OP 256 research platform. The beamformer sustains an average output sample rate of 470 MSPS. This allows continuously producing coherently compounded images, each of 64 lines by 1280 depths (here corresponding to 15.7 mm width and 45 mm depth, respectively), at frame rates up to 5.3 kHz. Imaging tests addressed to evaluate the achievable speed and quality performance were conducted on phantom. Results obtained by real-time compounding frames obtained with different numbers of steering angles between +7.5° and -7.5° are presented.

High Frame-Rate, High Resolution Ultrasound Imaging With Multi-Line Transmission and Filtered-Delay Multiply And Sum Beamforming

Multi-Line Transmission (MLT) was recently demonstrated as a valuable tool to increase the frame rate of ultrasound images. In this approach, the multiple beams that are simultaneously transmitted may determine cross-talk artifacts that are typically reduced, although not eliminated, by the use of Tukey apodization on both transmission and reception apertures, which unfortunately worsens the image lateral resolution. In this paper we investigate the combination, and related performance, of Filtered-Delay Multiply And Sum (F-DMAS) beamforming with MLT for high frame-rate ultrasound imaging. F-DMAS is a non-linear beamformer based on the computation of the receive aperture spatial autocorrelation, which was recently proposed for use in ultrasound B-mode imaging by some of the authors. The main advantages of such beamformer are the improved contrast resolution, obtained by lowering the beam side lobes and narrowing the main lobe, and the increased noise rejection. This study shows that in MLT images, compared to standard Delay And Sum (DAS) beamforming including Tukey apodization, F-DMAS beamforming yields better suppression of cross-talk and improved lateral resolution. The method's effectiveness is demonstrated by simulations and phantom experiments. Preliminary in vivo cardiac images also show that the frame rate can be improved up to 8-fold by combining F-DMAS and MLT without affecting the image quality.

Wideband 2-D Array Design Optimization With Fabrication Constraints for 3-D US Imaging

Ultrasound (US) 2-D arrays are of increasing interest due to their electronic steering capability to investigate 3-D regions without requiring any probe movement. These arrays are typically populated by thousands of elements that, ideally, should be individually driven by the companion scanner. Since this is not convenient, the so-called microbeamforming methods, yielding a prebeamforming stage performed in the probe handle by suitable custom integrated circuits, have so far been implemented in a few commercial high-end scanners. A possible approach to implement relatively cheap and efficient 3-D US imaging systems is using 2-D sparse arrays in which a limited number of elements can be coupled to an equal number of independent transmit/receive channels. In order to obtain US beams with adequate characteristics all over the investigated volume, the layout of such arrays must be carefully designed. This paper provides guidelines to design, by using simulated annealing optimization, 2-D sparse arrays capable of fitting specific applications or fabrication/implementation constraints. In particular, an original energy function based on multidepth 3-D analysis of the beam pattern is also exploited. A tutorial example is given, addressed to find the N _e elements that should be activated in a 2-D fully populated array to yield efficient acoustic radiating performance over the entire volume. The proposed method is applied to a 32 ×32 array centered at 3 MHz to select the 128, 192, and 256 elements that provide the best acoustic performance. It is shown that the 256-element optimized array yields sidelobe levels even lower (by 5.7 dB) than that of the reference 716-element circular and (by 10.3 dB) than that of the reference 1024-element array.

Wall Shear Rate Measurement: Validation of a New Method Through Multiphysics Simulations

Wall shear stress is known to affect the vessel endothelial function and to be related to important pathologies like the development of atherosclerosis. It is defined as the product of the blood viscosity by the blood velocity gradient at the wall position, i.e., the wall shear rate (WSR). The WSR measurement is particularly challenging in important cardiovascular sites, like the carotid bifurcation, because of the related complex flow configurations characterized by high spatial and temporal gradients, wall movement, and clutter noise. Moreover, accuracy of any method for WSR measurement can be effectively tested only if reliable gold standard WSR values, considering all the aforementioned disturbing effects, are available. Unfortunately, these requirements are difficult to achieve in a physical phantom, so that the accuracy test of the novel WSR measurement methods was so far limited to straight pipes and/or similar idealistic configurations. In this paper, we propose a new method for WSR measurement and its validation based on a mathematical model of the carotid bifurcation, which, exploiting fluid-structure simulations, is capable of reproducing realistic flow configuration, wall movement, and clutter noise. In particular, the profile near the wall, not directly measurable because affected by clutter, is estimated through a power-law fitting and compared with the gold standard provided by the model. In this condition, the WSR measurements featured an accuracy of ±20 %. A preliminary test on a volunteer confirmed the feasibility of the WSR method for in vivo application.

2-D Ultrasound Sparse Arrays Multidepth Radiation Optimization Using Simulated Annealing and Spiral-Array Inspired Energy Functions

Full matrix arrays are excellent tools for 3-D ultrasound imaging, but the required number of active elements is too high to be individually controlled by an equal number of scanner channels. The number of active elements is significantly reduced by the sparse array techniques, but the position of the remaining elements must be carefully optimized. This issue is faced here by introducing novel energy functions in the simulated annealing (SA) algorithm. At each iteration step of the optimization process, one element is freely translated and the associated radiated pattern is simulated. To control the pressure field behavior at multiple depths, three energy functions inspired by the pressure field radiated by a Blackman-tapered spiral array are introduced. Such energy functions aim at limiting the main lobe width while lowering the side lobe and grating lobe levels at multiple depths. Numerical optimization results illustrate the influence of the number of iterations, pressure measurement points, and depths, as well as the influence of the energy function definition on the optimized layout. It is also shown that performance close to or even better than the one provided by a spiral array, here assumed as reference, may be obtained. The finite-time convergence properties of SA allow the duration of the optimization process to be set in advance.

Coded Spectral Doppler Imaging: From Simulation to Real-Time Processing

Transmission of coded pulses and matched receive filtering can improve the ultrasound imaging penetration depth while preserving the axial resolution. This paper shows that the pulse compression technique may be integrated in a low-cost scanner to be profitably used also in spectral Doppler investigations. By operating on beamformed, demodulated, and down-sampled data in the frequency domain, a single digital signal processor is proved sufficient to perform both pulse compression and multigate spectral Doppler algorithms in real time. Simulations, phantom, and in vivo experiments demonstrate that the transmission of (2.5 or [Formula: see text] long) linear frequency-modulated chirps with bandwidths over the range 1.6-5.4 MHz, rather than of corresponding sine-burst pulses, provides signal-to-noise ratio (SNR) improvements very close to theory. Even in the presence of selective tissue attenuation, SNR gains up to 11 and 13.3 dB have been obtained for the short and the longer chirp, respectively. This may be important in clinical Doppler applications where the needed penetration depth is not achieved with sufficient SNR unless very long bursts are transmitted.

ULA-OP 256: A 256-Channel Open Scanner for Development and Real-Time Implementation of New Ultrasound Methods

Open scanners offer an increasing support to the ultrasound researchers who are involved in the experimental test of novel methods. Each system presents specific performance in terms of number of channels, flexibility, processing power, data storage capability, and overall dimensions. This paper reports the design criteria and hardware/software implementation details of a new 256-channel ultrasound advanced open platform. This system is organized in a modular architecture, including multiple front-end boards, interconnected by a high-speed (80 Gb/s) ring, capable of finely controlling all transmit (TX) and receive (RX) signals. High flexibility and processing power (equivalent to 2500 GFLOP) are guaranteed by the possibility of individually programming multiple digital signal processors and field programmable gate arrays. Eighty GB of on-board memory are available for the storage of prebeamforming, postbeamforming, and baseband data. The use of latest generation devices allowed to integrate all needed electronics in a small size ( 34 cm ×30 cm ×26 cm). The system implements a multiline beamformer that allows obtaining images of 96 lines by 2048 depths at a frame rate of 720 Hz (expandable to 3000 Hz). The multiline beamforming capability is also exploited to implement a real-time vector Doppler scheme in which a single TX and two independent RX apertures are simultaneously used to maintain the analysis over a full pulse repetition frequency range.

Wide-Angle Tissue Doppler Imaging at High Frame Rate Using Multi-Line Transmit Beamforming: An Experimental Validation In Vivo

Color tissue Doppler imaging (TDI) is a well-established methodology to assess local myocardial motion/deformation. Typically, a frame rate of ∼ 200 Hz can be achieved by imaging a narrow sector (∼ 30°, covering one cardiac wall) at moderate line density, using a dedicated pulse sequence and multi-line acquisition. However, a wide angle field-of-view is required in some clinical applications to image the whole left ventricle, which implies a drop in temporal resolution. Hereto, the aim of this study was to propose a novel imaging sequence using a multi-line transmit (MLT) beamforming approach to achieve high frame rate color TDI while preserving a wide field-of-view (i.e., 90° sector). To this end, a color MLT-TDI sequence achieving a frame rate of 208 Hz with a 90°-sector was implemented on an ultrasound experimental scanner interleaved with a conventional color TDI sequence achieving the same frame rate but only with a 22.5°-sector. Using this setup, the septal wall of 9 healthy volunteers was imaged and the corresponding velocity was extracted. The M-mode velocity images and the velocity profiles obtained from the MLT-TDI images presented physiologic patterns, very similar to those from conventional TDI. Moreover, for the peak systolic/diastolic velocities, good agreement and strong correlation between MLT-TDI and conventional TDI were found. The results thus demonstrate the feasibility of the novel MLT based TDI methodology to achieve high frame rate color TDI without compromising the field-of-view. This may open the opportunity to simultaneously assess regional myocardial function of the whole left ventricle at high temporal resolution.

Plane-wave transverse oscillation for high-frame-rate 2-D vector flow imaging

Transverse oscillation (TO) methods introduce oscillations in the pulse-echo field (PEF) along the direction transverse to the ultrasound propagation direction. This may be exploited to extend flow investigations toward multidimensional estimates. In this paper, the TOs are coupled with the transmission of plane waves (PWs) to reconstruct high-framerate RF images with bidirectional oscillations in the pulse-echo field. Such RF images are then processed by a 2-D phase-based displacement estimator to produce 2-D vector flow maps at thousands of frames per second. First, the capability of generating TOs after PW transmissions was thoroughly investigated by varying the lateral wavelength, the burst length, and the transmission frequency. Over the entire region of interest, the generated lateral wavelengths, compared with the designed ones, presented bias and standard deviation of -3.3 ± 5.7% and 10.6 ± 7.4% in simulations and experiments, respectively. The performance of the ultrafast vector flow mapping method was also assessed by evaluating the differences between the estimated velocities and the expected ones. Both simulations and experiments show overall biases lower than 20% when varying the beam-to-flow angle, the peak velocity, and the depth of interest. In vivo applications of the method on the common carotid and the brachial arteries are also presented.

Density-tapered spiral arrays for ultrasound 3-D imaging

The current high interest in 3-D ultrasound imaging is pushing the development of 2-D probes with a challenging number of active elements. The most popular approach to limit this number is the sparse array technique, which designs the array layout by means of complex optimization algorithms. These algorithms are typically constrained by a few steering conditions, and, as such, cannot guarantee uniform side-lobe performance at all angles. The performance may be improved by the ungridded extensions of the sparse array technique, but this result is achieved at the expense of a further complication of the optimization process. In this paper, a method to design the layout of large circular arrays with a limited number of elements according to Fermat's spiral seeds and spatial density modulation is proposed and shown to be suitable for application to 3-D ultrasound imaging. This deterministic, aperiodic, and balanced positioning procedure attempts to guarantee uniform performance over a wide range of steering angles. The capabilities of the method are demonstrated by simulating and comparing the performance of spiral and dense arrays. A good trade-off for small vessel imaging is found, e.g., in the 60λ spiral array with 1.0λ elements and Blackman density tapering window. Here, the grating lobe level is -16 dB, the lateral resolution is lower than 6λ the depth of field is 120λ and, the average contrast is 10.3 dB, while the sensitivity remains in a 5 dB range for a wide selection of steering angles. The simulation results may represent a reference guide to the design of spiral sparse array probes for different application fields.

A real-time chirp-coded imaging system with tissue attenuation compensation

In ultrasound imaging, pulse compression methods based on the transmission (TX) of long coded pulses and matched receive filtering can be used to improve the penetration depth while preserving the axial resolution (coded-imaging). The performance of most of these methods is affected by the frequency dependent attenuation of tissue, which causes mismatch of the receiver filter. This, together with the involved additional computational load, has probably so far limited the implementation of pulse compression methods in real-time imaging systems. In this paper, a real-time low-computational-cost coded-imaging system operating on the beamformed and demodulated data received by a linear array probe is presented. The system has been implemented by extending the firmware and the software of the ULA-OP research platform. In particular, pulse compression is performed by exploiting the computational resources of a single digital signal processor. Each image line is produced in less than 20 μs, so that, e.g., 192-line frames can be generated at up to 200 fps. Although the system may work with a large class of codes, this paper has been focused on the test of linear frequency modulated chirps. The new system has been used to experimentally investigate the effects of tissue attenuation so that the design of the receive compression filter can be accordingly guided. Tests made with different chirp signals confirm that, although the attainable compression gain in attenuating media is lower than the theoretical value expected for a given TX Time-Bandwidth product (BT), good SNR gains can be obtained. For example, by using a chirp signal having BT=19, a 13 dB compression gain has been measured. By adapting the frequency band of the receiver to the band of the received echo, the signal-to-noise ratio and the penetration depth have been further increased, as shown by real-time tests conducted on phantoms and in vivo. In particular, a 2.7 dB SNR increase has been measured through a novel attenuation compensation scheme, which only requires to shift the demodulation frequency by 1 MHz. The proposed method characterizes for its simplicity and easy implementation.

In vitro and in vivo tissue harmonic images obtained with parallel transmit beamforming by means of orthogonal frequency division multiplexing

In classic pulse-echo ultrasound imaging, the data acquisition rate is limited by the speed of sound. To overcome this, parallel beamforming techniques in transmit (PBT) and in receive (PBR) mode have been proposed. In particular, PBT techniques, based on the transmission of focused beams, are more suitable for harmonic imaging because they are capable of generating stronger harmonics. Recently, orthogonal frequency division multiplexing (OFDM) has been investigated as a means to obtain parallel beamformed tissue harmonic images. To date, only numerical studies and experiments in water have been performed, hence neglecting the effect of frequencydependent absorption. Here we present the first in vitro and in vivo tissue harmonic images obtained with PBT by means of OFDM, and we compare the results with classic B-mode tissue harmonic imaging. The resulting contrast-to-noise ratio, here used as a performance metric, is comparable. A reduction by 2 dB is observed for the case in which three parallel lines are reconstructed. In conclusion, the applicability of this technique to ultrasonography as a means to improve the data acquisition rate is confirmed.

High-frame-rate 2-D vector blood flow imaging in the frequency domain

Conventional ultrasound Doppler techniques estimate the blood velocity exclusively in the axial direction to produce the sonograms and color flow maps needed for diagnosis of cardiovascular diseases. In this paper, a novel method to produce bi-dimensional maps of 2-D velocity vectors is proposed. The region of interest (ROI) is illuminated by plane waves transmitted at the pulse repetition frequency (PRF) in a fixed direction. For each transmitted plane wave, the backscattered echoes are recombined offline to produce the radio-frequency image of the ROI. The local 2-D phase shifts between consecutive speckle images are efficiently estimated in the frequency domain, to produce vector maps up to 15 kHz PRF. Simulations and in vitro steady-flow experiments with different setup conditions have been conducted to thoroughly evaluate the method's performance. Bias is proved to be lower than 10% in most simulations and lower than 20% in experiments. Further simulations and in vivo experiments have been made to test the approach's feasibility in pulsatile flow conditions. It has been estimated that the computation of the frequency domain algorithm is more than 50 times faster than the computation of the reference 2-D cross-correlation algorithm.

Multi-transmit beam forming for fast cardiac imaging--experimental validation and in vivo application

High frame rate (HFR) echocardiography may be of benefit for functional analysis of the heart. In current clinical equipment, HFR is obtained using multi-line acquisition (MLA) which typically requires broadening of transmit beams. As this may result in a significant degradation of spatial resolution and signal-to-noise ratio (SNR), the capacity of MLA to obtain high quality HFR images remains limited. As an alternative, we have demonstrated by computer simulation that simultaneously transmitting multiple focused beams into different directions [multi-line transmit (MLT)], can increase the frame rate without significantly compromising the spatial resolution or SNR. This study aimed to experimentally verify these theoretical predictions both in vitro and in vivo to demonstrate, for the first time, that cardiac MLT imaging is feasible. Hereto, the ultrasound advanced open platform, equipped with a 2.0 MHz phased array, was programmed to interleave MLT and conventional single line transmit (SLT) beam forming. Using these two beam forming methods, images of phantoms and healthy volunteers were acquired and investigated both qualitatively and quantitatively. The results confirmed our simulations that image quality of a 4MLT imaging system with a Tukey apodization scheme is very competitive to that of SLT while providing a 4 times higher frame rate. It is also demonstrated that MLT can be combined with MLA to provide images at 12- to 16-fold frame rate (about 340-450 Hz) without significantly compromising spatial resolution and SNR. This is thus the first study to demonstrate that this new ultrasound imaging paradigm is viable which could have significant impact on future cardiac ultrasound systems.