Effects of perfusion on the viscoelastic characteristics of liver

Scale-dependent mechanical properties of native and decellularized liver tissue

Decellularization, a technique used in liver regenerative medicine, is the removal of all the cellular components from a tissue or organ, leaving behind an intact structure of extracellular matrix. The biomechanical properties of this novel scaffold material are currently unknown and are important due to the mechanosensitivity of liver cells. Characterizing this material is important for bioengineering liver tissue from this decellularized scaffold as well as creating new 3-dimensional mimetic structures of liver extracellular matrix. This study set out to characterize the biomechanical properties of perfused liver tissue in its native and decellularized states on both a macro- and nano-scale. Poroviscoelastic finite element models were then used to extract the fluid and solid mechanical properties from the experimental data. Tissue-level spherical indentation-relaxation tests were performed on 5 native livers and 8 decellularized livers at two indentation rates and at multiple perfusion rates. Cellular-level spherical nanoindentation was performed on 2 native livers and 1 decellularized liver. Tissue-level results found native liver tissue to possess a long-term Young's modulus of 10.5 kPa and decellularized tissue a modulus of 1.18 kPa. Cellular-level testing found native tissue to have a long-term Young's modulus of 4.40 kPa and decellularized tissue to have a modulus of 0.91 kPa. These results are important for regenerative medicine and tissue engineering where cellular response is dependent on the mechanical properties of the engineered scaffold.

Differentiation of benign from malignant liver masses with Acoustic Radiation Force Impulse technique

OBJECTIVE

The objective of the study was to determine the performance of Acoustic Radiation Force Impulse (ARFI) imaging to differentiate benign from malignant liver masses, both of hepatocellular origin and metastases, by quantification of their stiffness.

METHODS

This study has institutional review board approval and informed consent. Eighty-nine patients (42 female and 47 male patients) with 105 liver masses had ARFI evaluation on ultrasound, S2000 (Siemens, Mountain View, Calif). Mean age of the patients was 53.67 years (range, 27-83 years). Mean diameter of the masses was 2.77 cm (range, 1.0-13.0 cm). Final diagnoses, confirmed by imaging on contrast-enhanced computed tomography, magnetic resonance, or ultrasound or biopsy, include hepatocellular carcinoma (n = 28), metastasis (n = 13), hemangioma (n = 35), focal nodular hyperplasia (n = 15), focal fat sparing (n = 8), focal fat deposit (n = 4), and adenoma (n = 2). Receiver operating characteristic analysis was performed to evaluate the diagnostic accuracy of the ARFI measurement and to extract the optimal cutoff values in the differentiation of benign from malignant disease.

RESULTS

Acoustic Radiation Force Impulse values showed a statistically significant difference between benign (1.73 [SD, 0.8] m/sec) and malignant masses (2.57 [SD, 1.01] m/sec) (P < 0.001). However, the area under the receiver operating characteristic curve was 0.744, suggesting only fair accuracy. For differentiation of malignant from benign masses, the sensitivity, specificity, positive predictive value, and negative predictive value were 68% (28/41), 69% (44/64), 58% (28/48), and 77% (44/57), respectively, when 1.9 m/sec was chosen as a cutoff value, reflective of a wide variation of ARFI values in each diagnosis. For differentiation of metastasis from benign masses, sensitivity, specificity, positive predictive value, and NPV were 69% (9/13), 89% (57/64), 56% (9/16), and 93% (57/61), respectively, when 2.72 m/sec was chosen as a cutoff value.

CONCLUSIONS

Acoustic Radiation Force Impulse measurement may be helpful to differentiate benign masses from metastases, in particular. Otherwise, ARFI measurements alone do not differentiate benign and malignant masses because of variations in stiffness of all types of masses.

Analysis of several biomechanical models for the simulation of lamb liver behaviour using similarity coefficients from medical image

In this study, six biomechanical models for simulating lamb liver behaviour are presented. They are validated using similarity coefficients from Medical Image on reconstructed volumes from computerised tomography images. In particular, the Jaccard and Hausdorff coefficients are used. Loads of 20 and 40 g are applied to the livers and their deformation is simulated by means of the finite element method. The models used are a linear elastic model, a neo-Hookean model, a Mooney-Rivlin model, an Ogden model, a linear viscoelastic model and a viscohyperelastic model. The model that provided a behaviour that is closest to reality was the viscohyperelastic model, where the hyperelastic part was modelled with an Ogden model.

Characterizing the compression-dependent viscoelastic properties of human hepatic pathologies using dynamic compression testing

Recent advances in elastography have provided several imaging modalities capable of quantifying the elasticity of tissue, an intrinsic tissue property. This information is useful for determining tumour margins and may also be useful for diagnosing specific tumour types. In this study, we used dynamic compression testing to quantify the viscoelastic properties of 16 human hepatic primary and secondary malignancies and their corresponding background tissue obtained following surgical resection. Two additional backgrounds were also tested. An analysis of the background tissue showed that F4-graded fibrotic liver tissue was significantly stiffer than F0-graded tissue, with a modulus contrast of 4:1. Steatotic liver tissue was slightly stiffer than normal liver tissue, but not significantly so. The tumour-to-background storage modulus contrast of hepatocellular carcinomas, a primary tumour, was approximately 1:1, and the contrast decreased with increasing fibrosis grade of the background tissue. Ramp testing showed that the background stiffness increased faster than the malignant tissue. Conversely, secondary tumours were typically much stiffer than the surrounding background, with a tumour-to-background contrast of 10:1 for colon metastases and 10:1 for cholangiocarcinomas. Ramp testing showed that colon metastases stiffened faster than their corresponding backgrounds. These data have provided insights into the mechanical properties of specific tumour types, which may prove beneficial as the use of quantitative stiffness imaging increases.

Dynamic mechanical response of brain tissue in indentation in vivo, in situ and in vitro

Characterizing the dynamic mechanical properties of brain tissue is deemed important for developing a comprehensive knowledge of the mechanisms underlying brain injury. The results gathered to date on the tissue properties have been mostly obtained in vitro. Learning how these results might differ quantitatively from those encountered in vivo is a critical step towards the development of biofidelic brain models. The present study provides novel and unique experimental results on, and insights into, brain biorheology in vivo, in situ and in vitro, at large deformations, in the quasi-static and dynamic regimes. The nonlinear dynamic response of the cerebral cortex was measured in indentation on the exposed frontal and parietal lobes of anesthetized porcine subjects. Load-unload cycles were applied to the tissue surface at sinusoidal frequencies of 10, 1, 0.1 and 0.01 Hz. Ramp-relaxation tests were also conducted to assess the tissue viscoelastic behavior at longer times. After euthanasia, the indentation test sequences were repeated in situ on the exposed cortex maintained in its native configuration within the cranium. Mixed gray and white matter samples were subsequently excised from the superior cortex to be subjected to identical indentation test segments in vitro within 6-7 h post mortem. The main response features (e.g. nonlinearities, rate dependencies, hysteresis and conditioning) were measured and contrasted in vivo, in situ and in vitro. The indentation response was found to be significantly stiffer in situ than in vivo. The consistent, quantitative set of mechanical measurements thereby collected provides a preliminary experimental database, which may be used to support the development of constitutive models for the study of mechanically mediated pathways leading to traumatic brain injury.

Pressure-based abdominal injury criteria using isolated liver and full-body post-mortem human subject impact tests

Liver trauma research suggests that rapidly increasing internal pressure plays a role in liver injury. Previous work has shown a correlation between pressure and liver injury in pressurized ex vivo human livers when subjected to blunt impacts. The purpose of this study was to extend the investigation of this relationship between pressure and liver injury by testing full-body post-mortem human surrogates (PMHS). Pressure-related variables were compared with one another and also to previously proposed biomechanical predictors of abdominal injury. Ten PMHS were tested. The abdominal vessels were pressurized to physiological levels using saline, and a pneumatic ram impacted the right side of the specimen ribcage at a nominal velocity of 7.0 m/s. Specimens were subjected to either lateral (n = 5) or oblique (n = 5) impacts, and the impact- induced pressures were measured by transducers inserted into the hepatic veins and inferior vena cava. The liver injuries observed were similar to those documented in the Crash Injury Research Engineering Network (CIREN) trauma database. Using binary logistic regression to develop injury risk functions, it was determined the peak rate of pressure change (Ṗmax) was a statistically significant predictor of AIS ≥ 3 liver injury for both the PMHS and ex vivo testing. This suggests that Ṗmax is a good predictor of liver injury regardless of the impact boundary conditions.

Identifying a minimal rheological configuration: a tool for effective and efficient constitutive modeling of soft tissues

We describe a modeling methodology intended as a preliminary step in the identification of appropriate constitutive frameworks for the time-dependent response of biological tissues. The modeling approach comprises a customizable rheological network of viscous and elastic elements governed by user-defined 1D constitutive relationships. The model parameters are identified by iterative nonlinear optimization, minimizing the error between experimental and model-predicted structural (load-displacement) tissue response under a specific mode of deformation. We demonstrate the use of this methodology by determining the minimal rheological arrangement, constitutive relationships, and model parameters for the structural response of various soft tissues, including ex vivo perfused porcine liver in indentation, ex vivo porcine brain cortical tissue in indentation, and ex vivo human cervical tissue in unconfined compression. Our results indicate that the identified rheological configurations provide good agreement with experimental data, including multiple constant strain rate load/unload tests and stress relaxation tests. Our experience suggests that the described modeling framework is an efficient tool for exploring a wide array of constitutive relationships and rheological arrangements, which can subsequently serve as a basis for 3D constitutive model development and finite-element implementations. The proposed approach can also be employed as a self-contained tool to obtain simplified 1D phenomenological models of the structural response of biological tissue to single-axis manipulations for applications in haptic technologies.

Perception and Action in Teleoperated Needle Insertion

We studied the effect of delay on perception and action in contact with a force field that emulates elastic soft tissue with a rigid nonlinear boundary. Such a field is similar to forces exerted on a needle during teleoperated needle insertion. We found that delay causes motor underestimation of the stiffness of this nonlinear soft tissue, without perceptual change. These experimental results are supported by simulation of a simplified mechanical model of the arm and neural controller, and a model for perception of stiffness, which is based on regression in the force-position space. In addition, we show that changing the gain of the teleoperation channel cancels the motor effect of delay without adding perceptual distortion. We conclude that it is possible to achieve perceptual and motor transparency in virtual one-dimensional remote needle insertion task.

Development of in vivo constitutive models for liver: application to surgical simulation

Advancements in real-time surgical simulation techniques have provided the ability to utilize more complex nonlinear constitutive models for biological tissues which result in increased haptic and graphic accuracy. When developing such a model, verification is necessary to determine the accuracy of the force response as well as the magnitude of tissue deformation for tool-tissue interactions. In this study, we present an experimental device which provides the ability to obtain force-displacement information as well as surface deformation of porcine liver for in vivo probing tasks. In addition, the system is capable of accurately determining the geometry of the liver specimen. These combined attributes provide the context required to simulate the experiment with accurate boundary conditions, whereby the only variable in the analysis is the material properties of the liver specimen. During the simulation, effects of settling due to gravity have been taken into account by a technique which incorporates the proper internal stress conditions in the model without altering the geometry. Initially, an Ogden model developed from ex vivo tension and compression experimentation is run through the simulation to determine the efficacy of utilizing an ex vivo model for simulation of in vivo probing tasks on porcine liver. Subsequently, a method for improving upon the ex vivo model was developed using different hyperelastic models such that increased accuracy could be achieved for the force characteristics compared to the displacement characteristics, since changes in the force variation would be more perceptible to a user in the simulation environment, while maintaining a high correlation with the surface displacement data. Furthermore, this study also presents the probing simulation which includes the capsule surrounding the liver.

Effect of Preservation Period on the Viscoelastic Material Properties of Soft Tissues With Implications for Liver Transplantation

The liver harvested from a donor must be preserved and transported to a suitable recipient immediately for a successful liver transplantation. In this process, the preservation period is the most critical, since it is the longest and most tissue damage occurs during this period due to the reduced blood supply to the harvested liver and the change in its temperature. We investigate the effect of preservation period on the dynamic material properties of bovine liver using a viscoelastic model derived from both impact and ramp and hold experiments. First, we measure the storage and loss moduli of bovine liver as a function of excitation frequency using an impact hammer. Second, its time-dependent relaxation modulus is measured separately through ramp and hold experiments performed by a compression device. Third, a Maxwell solid model that successfully imitates the frequency- and time-dependent dynamic responses of bovine liver is developed to estimate the optimum viscoelastic material coefficients by minimizing the error between the experimental data and the corresponding values generated by the model. Finally, the variation in the viscoelastic material coefficients of bovine liver are investigated as a function of preservation period for the liver samples tested 1 h, 2 h, 4 h, 8 h, 12 h, 24 h, 36 h, and 48 h after harvesting. The results of our experiments performed with three animals show that the liver tissue becomes stiffer and more viscous as it spends more time in the preservation cycle.

Dispersion and shear modulus measurements of porcine liver

A narrow-band ultrasonic shear-wave imaging technique for estimating phase speed was applied to fresh and thermally damaged porcine liver in vitro. Two constitutive models were applied to the measurements to represent rheological behavior of the tissue and estimate the complex shear modulus at frequencies between 50 and 300 Hz. Our results were compared to similar values from the literature to assess how well models represent liver measurements over a range of shear-wave frequencies, experimental conditions and mammalian species. We found remarkable consistency in some parameters but not in others, suggesting that the Kelvin-Voigt model commonly applied in elasticity-imaging situations is representative of tissue dispersion but the description it offers is incomplete. Data are consistent with the theory that viscoelastic contrast is more likely due to changes in protein and other biomolecular-scale structures than from tissue anatomy larger than a cell. Dispersion measurements at frequencies between 0.5-1000 kHz are needed to more completely evaluate models for the viscoelastic behavior liver.

Portal pressure determined by perfusion velocity in isolated chronically injured rat liver in vitro

AIM: To establish equations to define portal pressure based upon perfusion velocity in isolated chronically injured rat liver.

METHODS: Chronic liver injury was induced in Wistar rats using carbon tetrachloride. The liver index and pathological changes were recorded. On days 0, 28, 56 and 84 after induction of chronic liver injury, the hepatic artery, portal vein and hepatic vein were cannulated. The residual blood in the isolated liver was eliminated with Krebs-Henseleit solution through the hepatic artery. Portal vein perfusion velocities were precisely controlled between 2 500 μL/min to 15 630 μL/min with a pump. The pressure (mmHg) was monitored using the BL-420S physiological experiment system. The equations for estimating portal pressure were developed using Prism-4 software, and median velocities and their 95% confidence intervals were calculated.

RESULTS: On days 0, 28, 56 and 84, the equations for estimating portal pressure (mmHg) based on the logarithmic velocity (μL/min) in isolated rat liver were y = -0.1428+1.1423/[1+10^{(13.805-3.84x)}] (r² = 0.9996), y = -0.1570+1.419/ [1+10^{(4.666-1.27x)}] (r² = 0.9958), y = 0.05106+0.96594/[1+10^{(10.877- 2.958x)}] (r² = 0.9987), and y = -0.09893+1.406/[1+10^(4.3-1.158x)] (r² = 0.9989), respectively. The median velocities (95% confidence intervals) were 3.595 (3.561-3.628), 3.674 (3.285-4.064), 3.677 (3.614-3.740) and 3.713 (3.449-3.977), respectively.

CONCLUSION: The equations for estimating portal pressure based on the logarithmic velocity in isolated rat liver are similar at different time points during the progression of carbon tetrachloride-induced chronic liver injury. A dry model of systems biology for portal pharmacodynamics could be derived from the increased median perfusion velocities.

A proto-type design of a real-tissue phantom for the validation of deformation algorithms and 4D dose calculations

The purpose of this study is to design a real-tissue phantom for use in the validation of deformation algorithms. A phantom motion controller that runs sinusoidal and non-regular patient-based breathing pattern, via a piston, was applied to porcine liver tissue. It was regulated to simulate movement ranges similar to recorded implanted liver markers from patients. 4D CT was applied to analyze deformation. The suitability of various markers in the liver and the position reproducibility of markers and of reference points were studied. The similarity of marker motion pattern in the liver phantom and in real patients was evaluated. The viability of the phantom over time and its use with electro-magnetic tracking devices were also assessed. High contrast markers, such as carbon markers, implanted in the porcine liver produced less image artifacts on CT and were well visualized compared to metallic ones. The repositionability of markers was within a measurement accuracy of +/-2 mm. Similar anatomical patient motions were reproducible up to elongations of 3 cm for a time period of at least 90 min. The phantom is compatible with electro-magnetic tracking devices and 4D CT. The phantom motion is reproducible and simulates realistic patient motion and deformation. The ability to carry out voxel-based tracking allows for the evaluation of deformation algorithms in a controlled environment with recorded patient traces. The phantom is compatible with all therapy devices clinically encountered in our department.

Estimating zero-strain states of very soft tissue under gravity loading using digital image correlation

This paper presents several experimental techniques and concepts in the process of measuring mechanical properties of very soft tissue in an ex vivo tensile test. Gravitational body force on very soft tissue causes pre-compression and results in a non-uniform initial deformation. The global digital image correlation technique is used to measure the full-field deformation behavior of liver tissue in uniaxial tension testing. A maximum stretching band is observed in the incremental strain field when a region of tissue passes from compression and enters a state of tension. A new method for estimating the zero-strain state is proposed: the zero strain position is close to, but ahead of the position of the maximum stretching band, or in other words, the tangent of a nominal stress-stretch curve reaches minimum at lambda greater or similar 1. The approach, to identify zero strain by using maximum incremental strain, can be implemented in other types of image-based soft tissue analysis. The experimental results of 10 samples from seven porcine livers are presented and material parameters for the Ogden model fit are obtained. The finite element simulation based on the fitted model confirms the effect of gravity on the deformation of very soft tissue and validates our approach.

A strain-hardening bi-power law for the nonlinear behaviour of biological soft tissues

Biological soft tissues exhibit a strongly nonlinear viscoelastic behaviour. Among parenchymous tissues, kidney and liver remain less studied than brain, and a first goal of this study is to report additional material properties of kidney and liver tissues in oscillatory shear and constant shear rate tests. Results show that the liver tissue is more compliant but more strain hardening than kidney. A wealth of multi-parameter mathematical models has been proposed for describing the mechanical behaviour of soft tissues. A second purpose of this work is to develop a new constitutive law capable of predicting our experimental data in the both linear and nonlinear viscoelastic regime with as few parameters as possible. We propose a nonlinear strain-hardening fractional derivative model in which six parameters allow fitting the viscoelastic behaviour of kidney and liver tissues for strains ranging from 0.01 to 1 and strain rates from 0.0151 s(-1) to 0.7s(-1).

Constitutive modeling of liver tissue: experiment and theory

Realistic surgical simulation requires incorporation of the mechanical properties of soft tissue in mathematical models. In actual deformation of soft-tissue during surgical intervention, the tissue is subject to tension, compression, and shear. Therefore, characterization and modeling of soft-tissue in all these three deformation modes are necessary. In this paper we applied two types of pure shear test, un-confined compression and uniaxial tension test to characterize porcine liver tissue. Digital image correlation technique was used to accurately measure the tissue deformation field. Due to gravity and its effect on the soft tissue, a maximum stretching band was observed from the relative strain field on sample undergoing tension and pure shear test. The zero strain state was identified according to the position of this maximum stretching band. Two new constitutive models based on combined exponential/logarithmic and Ogden strain energy were proposed. The models are capable to represent the observed non-linear stress-strain relation of liver tissue for full range of tension and compression and also the general response of pure shear.

Constitutive modeling of porcine liver in indentation using 3D ultrasound imaging

In this work we present an inverse finite-element modeling framework for constitutive modeling and parameter estimation of soft tissues using full-field volumetric deformation data obtained from 3D ultrasound. The finite-element model is coupled to full-field visual measurements by regularization springs attached at nodal locations. The free ends of the springs are displaced according to the locally estimated tissue motion, and the normalized potential energy stored in all springs serves as a measure of model-experiment agreement for material parameter optimization. We demonstrate good accuracy of estimated parameters and consistent convergence properties on synthetically generated data. We present constitutive model selection and parameter estimation for perfused porcine liver in indentation, and demonstrate that a quasilinear viscoelastic model with shear modulus relaxation offers good model-experiment agreement in terms of indenter displacement (0.19 mm RMS error) and tissue displacement field (0.97 mm RMS error).

Combined optical imaging and mammography of the healthy breast: optical contrast derived from breast structure and compression

In this paper, we report new progress in developing the instrument and software platform of a combined X-ray mammography/diffuse optical breast imaging system. Particularly, we focus on system validation using a series of balloon phantom experiments and the optical image analysis of 49 healthy patients. Using the finite-element method for forward modeling and a regularized Gauss-Newton method for parameter reconstruction, we recovered the inclusions inside the phantom and the hemoglobin images of the human breasts. An enhanced coupling coefficient estimation scheme was also incorporated to improve the accuracy and robustness of the reconstructions. The recovered average total hemoglobin concentration (HbT) and oxygen saturation (SO2) from 68 breast measurements are 16.2 microm and 71%, respectively, where the HbT presents a linear trend with breast density. The low HbT value compared to literature is likely due to the associated mammographic compression. From the spatially co-registered optical/X-ray images, we can identify the chest-wall muscle, fatty tissue, and fibroglandular regions with an average HbT of 20.1+/-6.1 microm for fibroglandular tissue, 15.4+/-5.0 microm for adipose, and 22.2+/-7.3 microm for muscle tissue. The differences between fibroglandular tissue and the corresponding adipose tissue are significant (p < 0.0001). At the same time, we recognize that the optical images are influenced, to a certain extent, by mammographical compression. The optical images from a subset of patients show composite features from both tissue structure and pressure distribution. We present mechanical simulations which further confirm this hypothesis.

Biomechanical Properties of Abdominal Organs In Vivo and Postmortem Under Compression Loads

Accurate knowledge of biomechanical characteristics of tissues is essential for developing realistic computer-based surgical simulators incorporating haptic feedback, as well as for the design of surgical robots and tools. As simulation technologies continue to be capable of modeling more complex behavior, an in vivo tissue property database is needed. Most past and current biomechanical research is focused on soft and hard anatomical structures that are subject to physiological loading, testing the organs in situ. Internal organs are different in that respect since they are not subject to extensive loads as part of their regular physiological function. However, during surgery, a different set of loading conditions are imposed on these organs as a result of the interaction with the surgical tools. Following previous research studying the kinematics and dynamics of tool/tissue interaction in real surgical procedures, the focus of the current study was to obtain the structural biomechanical properties (engineering stress-strain and stress relaxation) of seven abdominal organs, including bladder, gallbladder, large and small intestines, liver, spleen, and stomach, using a porcine animal model. The organs were tested in vivo, in situ, and ex corpus (the latter two conditions being postmortem) under cyclical and step strain compressions using a motorized endoscopic grasper and a universal-testing machine. The tissues were tested with the same loading conditions commonly applied by surgeons during minimally invasive surgical procedures. Phenomenological models were developed for the various organs, testing conditions, and experimental devices. A property database—unique to the literature—has been created that contains the average elastic and relaxation model parameters measured for these tissues in vivo and postmortem. The results quantitatively indicate the significant differences between tissue properties measured in vivo and postmortem. A quantitative understanding of how the unconditioned tissue properties and model parameters are influenced by time postmortem and loading condition has been obtained. The results provide the material property foundations for developing science-based haptic surgical simulators, as well as surgical tools for manual and robotic systems.

The spatio-temporal strain response of oedematous and nonoedematous tissue to sustained compression in vivo

Poroelastic theory predicts that compression-induced fluid flow through a medium reveals itself via the spatio-temporal behaviour of the strain field. Such strain behaviour has already been observed in simple poroelastic phantoms using generalised elastographic techniques (Berry et al. 2006a, 2006b). The aim of this current study was to investigate the extent to which these techniques could be applied in vivo to image and interpret the compression-induced time-dependent local strain response in soft tissue. Tissue on both arms of six patients presenting with unilateral lymphoedema was subjected to a sustained compression for up to 500 s, and the induced strain was imaged as a function of time. The strain was found to exhibit time-dependent spatially varying behaviour, which we interpret to be consistent with that of a heterogeneous poroelastic material. This occurred in both arms of all patients, although it was more easily seen in the ipsilateral (affected) arm than in the contralateral (apparently unaffected) arm in five out of the six patients. Further work would appear to be worthwhile to determine if poroelasticity imaging could be used in future both to diagnose lymphoedema and to explore the patho-physiology of the condition.

A light sterilizable pipette device for the in vivo estimation of human soft tissues constitutive laws

This paper introduces a new light device for the in vivo estimation of human soft tissues constitutive laws. It consists of an aspiration pipette able to meet the very severe sterilization and handling issues imposed during surgery. The simplicity of the device, free of any electronic circuitry, allows using it as an ancillary instrument. The deformation of the aspired tissue is imaged via a mirror using an external camera. The paper describes the experimental setup as well as the protocol that should be used during surgery. First feasibility measurements are shown for human tongue and forearm skin.

The mechanical response of human liver and its relation to histology: an in vivo study

The mechanical response of human liver is characterized in vivo by means of intra-operative aspiration experiments. Mechanical characterization is combined with histological evaluation of liver tissue biopsies obtained from the resected liver at the site of mechanical testing. This procedure enables a quantitative analysis of the correlation between mechanical response and tissue micro-structure of normal and diseased liver. Ten organs were tested in vivo at multiple locations, as well as ex vivo immediately after resection. Biopsies were analyzed in terms of pathology and percentage of connective tissue content. The change of the mechanical parameters from in vivo to ex vivo has been determined, with an increase of 17% of the proposed stiffness index. The relationship between mechanical parameters and various pathologic conditions affecting the tissue samples has been quantified, with fibrosis leading to a response up to three times stiffer as compared with normal tissue. Increased stiffness can be detected by digital palpation (increased "consistency") and may suggest the presence of a tumor. The present observations suggest that stiffness increase cannot be attributed to the tumoral tissue itself, but rather to the fibrotic stroma that often arise within or adjacent to the tumor. Variation of the mechanical parameters as a function of connective tissue content has been evaluated based on the histological examinations and the results confirm a direct proportionality between stiffness index and connective tissue percentage. The approach described here might eventually lead to a diagnostic procedure and complement other clinical methods, like palpation and ultrasound examination of the liver.

Towards an acoustic model-based poroelastic imaging method: II. experimental investigation

Soft biological tissue contains mobile fluid. The volume fraction of this fluid and the ease with which it may be displaced through the tissue could be of diagnostic significance and may also have consequences for the validity with which strain images can be interpreted according to the traditional idealizations of elastography. In a previous paper, under the assumption of frictionless boundary conditions, the spatio-temporal behavior of the strain field inside a compressed cylindrical poroelastic sample was predicted (Berry et al. 2006). In this current paper, experimental evidence is provided to confirm these predictions. Finite element modeling was first used to extend the previous predictions to allow for the existence of contact friction between the sample and the compressor plates. Elastographic techniques were then applied to image the time-evolution of the strain inside cylindrical samples of tofu (a suitable poroelastic material) during sustained unconfined compression. The observed experimental strain behavior was found to be consistent with the theoretical predictions. In particular, every sample studied confirmed that reduced values of radial strain advance with time from the curved cylindrical surface inwards towards the axis of symmetry. Furthermore, by fitting the predictions of an analytical model to a time sequence of strain images, parametric images of two quantities, each related to one or more of three poroelastic material constants were produced. The two parametric images depicted the Poisson's ratio (nu(s)) of the solid matrix and the product of the aggregate modulus (H(A)) of the solid matrix with the permeability (k) of the solid matrix to the pore fluid. The means of the pixel values in these images, nu(s) = 0.088 (standard deviation 0.023) and H(A)k = 1.449 (standard deviation 0.269) x 10(-7) m(2) s(-1), were in agreement with values derived from previously published data for tofu (Righetti et al. 2005). The results provide the first experimental detection of the fluid-flow-induced characteristic diffusion-like behavior of the strain in a compressed poroelastic material and allow parameters related to the above material constants to be determined. We conclude that it may eventually be possible to use strain data to detect and measure characteristics of diffusely distributed mobile fluid in tissue spaces that are too small to be imaged directly.

Biomechanical response of the pediatric abdomen, part 1: development of an experimental model and quantification of structural response to dynamic belt loading

The abdomen is the second most commonly injured region in children using adult seat belts, but engineers are limited in their efforts to design systems that mitigate these injuries since no current pediatric dummy has the capability to quantify injury risk from loading to the abdomen. This paper develops a porcine (sus scrofa domestica) model of the 6-year-old human's abdomen, and then defines the biomechanical response of this abdominal model. First, a detailed abdominal necropsy study was undertaken, which involved collecting a series of anthropometric measurements and organ masses on 25 swine, ranging in age from 14 to 429 days (4-101 kg mass). These were then compared to the corresponding human quantities to identify the best porcine representation of a 6-year-old human's abdomen. This was determined to be a pig of age 77 days, and whole-body mass of 21.4 kg. The sub-injury, quasistatic response to belt loading of this porcine model compared well with pediatric human volunteer tests performed with a lap belt on the lower abdomen. A test fixture was designed to produce transverse, dynamic belt loading on the porcine abdomen. A detailed review of field cases identified the following test variables: loading location (upper/lower), penetration magnitude (23%-68% of initial abdominal depth), muscle tensing (yes/no), and belt penetration rate (quasistatic, dynamic 2.9 m/s - 7.8 m/s). Dynamic tests were performed on 47 post-mortem subjects. Belt tension and dorsal reaction force were cross-plotted with abdominal penetration to generate structural response corridors. Subcutaneous stimulation of the anterior abdominal muscle wall stiffened the quasistatic response significantly, but was of negligible importance in the dynamic tests. The upper abdomen exhibited stiffer response quasistatically, and also was more sensitive to penetration rate, with stiffness increasing significantly over the range of dynamic rates tested here. In contrast, the lower abdomen was relatively rate insensitive. To our knowledge, this is the only dynamic structural characterization study on a comprehensively developed experimental model of the 6-year-old human abdomen. The structural corridors developed here should lead to the development of both mechanical (i.e., crash dummies) and computational pediatric models that are more useful for assessing injurious levels of belt penetration into the abdomen.