Visualization and quantification of breast cancer biomechanical properties with magnetic resonance elastography

Mechanical imaging of the breast

In this paper, we analyze the physical basis for elasticity imaging of the breast by measuring breast skin stress patterns that result from a force sensor array pressed against the breast tissue. Temporal and spatial changes in the stress pattern allow detection of internal structures with different elastic properties and assessment of geometrical and mechanical parameters of these structures. The method entitled mechanical imaging is implemented in the breast mechanical imager (BMI), a compact device consisting of a hand held probe equipped with a pressure sensor array, a compact electronic unit, and a touchscreen laptop computer. Data acquired by the BMI allows calculation of size, shape, consistency/hardness, and mobility of detected lesions. The BMI prototype has been validated in laboratory experiments on tissue models and in an ongoing clinical study. The obtained results prove that the BMI has potential to become a screening and diagnostic tool that could largely supplant clinical breast examination through its higher sensitivity, quantitative record storage, ease-of-use, and inherent low cost.

Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging

This paper presents an initial clinical evaluation of in vivo elastography for breast lesion imaging using the concept of supersonic shear imaging. This technique is based on the combination of a radiation force induced in tissue by an ultrasonic beam and an ultrafast imaging sequence capable of catching in real time the propagation of the resulting shear waves. The local shear wave velocity is recovered using a time-offlight technique and enables the 2-D mapping of shear elasticity. This imaging modality is implemented on a conventional linear probe driven by a dedicated ultrafast echographic device. Consequently, it can be performed during a standard echographic examination. The clinical investigation was performed on 15 patients, which corresponded to 15 lesions (4 cases BI-RADS 3, 7 cases BI-RADS 4 and 4 cases BI-RADS 5). The ability of the supersonic shear imaging technique to provide a quantitative and local estimation of the shear modulus of abnormalities with a millimetric resolution is illustrated on several malignant (invasive ductal and lobular carcinoma) and benign cases (fibrocystic changes and viscous cysts). In the investigated cases, malignant lesions were found to be significantly different from benign solid lesions with respect to their elasticity values. Cystic lesions have shown no shear wave propagate at all in the lesion (because shear waves do not propage in liquid). These preliminary clinical results directly demonstrate the clinical feasibility of this new elastography technique in providing quantitative assessment of relative stiffness of breast tissues. This technique of evaluating tissue elasticity gives valuable information that is complementary to the B-mode morphologic information. More extensive studies are necessary to validate the assumption that this new mode potentially helps the physician in both false-positive and false-negative rejection.

Instrument for determining the complex shear modulus of soft-tissue-like materials from 10 to 300 Hz

Accurate determination of the complex shear modulus of soft tissues and soft-tissue-like materials in the 10-300 Hz frequency range is very important to researchers in MR elastography and acoustic radiation force impulse (ARFI) imaging. A variety of instruments for making such measurements has been reported, but none of them is easily reproduced, and none have been tested to conform to causality via the Kramers-Kronig (K-K) relations. A promising linear oscillation instrument described in a previous brief report operates between 20 and 160 Hz, but results were not tested for conformity to the K-K relations. We have produced a similar instrument with our own version of the electronic components and have also accounted for instrumental effects on the data reduction, which is not addressed in the previous report. The improved instrument has been shown to conform to an accurate approximation of the K-K relations over the 10-300 Hz range. The K-K approximation is based on the Weichert mechanical circuit model. We also found that the sample thickness must be small enough to obtain agreement with a calibrated commercial rheometer. A complete description of the improved instrument is given, facilitating replication in other labs.

Extracellular matrix rigidity promotes invadopodia activity

Invadopodia are actin-rich subcellular protrusions with associated proteases used by cancer cells to degrade extracellular matrix (ECM) [1]. Molecular components of invadopodia include branched actin-assembly proteins, membrane trafficking proteins, signaling proteins, and transmembrane proteinases [1]. Similar structures exist in nontransformed cells, such as osteoclasts and dendritic cells, but are generally called podosomes and are thought to be more involved in cell-matrix adhesion than invadopodia [2-4]. Despite intimate contact with their ECM substrates, it is unknown whether physical or chemical ECM signals regulate invadopodia function. Here, we report that ECM rigidity directly increases both the number and activity of invadopodia. Transduction of ECM-rigidity signals depends on the cellular contractile apparatus [5-7], given that inhibition of nonmuscle myosin II, myosin light chain kinase, and Rho kinase all abrogate invadopodia-associated ECM degradation. Whereas myosin IIA, IIB, and phosphorylated myosin light chain do not localize to invadopodia puncta, active phosphorylated forms of the mechanosensing proteins p130Cas (Cas) and focal adhesion kinase (FAK) are present in actively degrading invadopodia, and the levels of phospho-Cas and phospho-FAK in invadopodia are sensitive to myosin inhibitors. Overexpression of Cas or FAK further enhances invadopodia activity in cells plated on rigid polyacrylamide substrates. Thus, in invasive cells, ECM-rigidity signals lead to increased matrix-degrading activity at invadopodia, via a myosin II-FAK/Cas pathway. These data suggest a potential mechanism, via invadopodia, for the reported correlation of tissue density with cancer aggressiveness.

In vivo brain viscoelastic properties measured by magnetic resonance elastography

Magnetic resonance elastography (MRE) is a non-invasive imaging technique used to visualise and quantify mechanical properties of tissue, providing information beyond what can be currently achieved with standard MR sequences and could, for instance, provide new insight into pathological processes in the brain. This study uses the MRE technique at 3 T to extract the complex shear modulus for in vivo brain tissue utilizing a full three-dimensional approach to reconstruction, removing contributions of the dilatational wave by application of the curl operator. A calibrated phantom is used to benchmark the MRE measurements, and in vivo results are presented for healthy volunteers. The results provide data for in vivo brain storage modulus (G'), finding grey matter (3.1 kPa) to be significantly stiffer than white matter (2.7 kPa). The first in vivo loss modulus (G'') measurements show no significant difference between grey matter (2.5 kPa) and white matter (2.5 kPa).

Imaging and cancer: a review

Multiple biomedical imaging techniques are used in all phases of cancer management. Imaging forms an essential part of cancer clinical protocols and is able to furnish morphological, structural, metabolic and functional information. Integration with other diagnostic tools such as in vitro tissue and fluids analysis assists in clinical decision-making. Hybrid imaging techniques are able to supply complementary information for improved staging and therapy planning. Image guided and targeted minimally invasive therapy has the promise to improve outcome and reduce collateral effects. Early detection of cancer through screening based on imaging is probably the major contributor to a reduction in mortality for certain cancers. Targeted imaging of receptors, gene therapy expression and cancer stem cells are research activities that will translate into clinical use in the next decade. Technological developments will increase imaging speed to match that of physiological processes. Targeted imaging and therapeutic agents will be developed in tandem through close collaboration between academia and biotechnology, information technology and pharmaceutical industries.

Monitored steady-state excitation and recovery (MSSER) radiation force imaging using viscoelastic models

Acoustic radiation force imaging methods distinguish tissue structure and composition by monitoring tissue responses to applied radiation force excitations. Although these responses are a complex, multidimensional function of the geometric and viscoelastic nature of tissue, simplified discrete biomechanical models offer meaningful insight to the physical phenomena that govern induced tissue motion. Applying Voigt and standard linear viscoelastic tissue models, we present a new radiation force technique - monitored steady-state excitation and recovery (MSSER) imaging - that tracks both steady-state displacement during prolonged force application and transient response following force cessation to estimate tissue mechanical properties such as elasticity and viscosity. In concert with shear wave elasticity imaging (SWEI) estimates for Young's modulus, MSSER methods are useful for estimating tissue mechanical properties independent of the applied force magnitude. We test our methods in gelatin phantoms and excised pig muscle, with confirmation through mechanical property measurement. Our results measured 10.6 kPa, 14.7 kPa, and 17.1 kPa (gelatin) and 122.4 kPa (pig muscle) with less than 10% error. This work demonstrates the feasibility of MSSER imaging and merits further efforts to incorporate relevant mechanical tissue models into the development of novel radiation force imaging techniques.

Ability of magnetic resonance elastography to assess taut bands

BACKGROUND

Myofascial taut bands are central to diagnosis of myofascial pain. Despite their importance, we still lack either a laboratory test or imaging technique capable of objectively confirming either their nature or location. This study explores the ability of magnetic resonance elastography to localize and investigate the mechanical properties of myofascial taut bands on the basis of their effects on shear wave propagation.

METHODS

This study was conducted in three phases. The first involved the imaging of taut bands in gel phantoms, the second a finite element modeling of the phantom experiment, and the third a preliminary evaluation involving eight human subjects-four of whom had, and four of whom did not have myofascial pain. Experiments were performed with a 1.5 T magnetic resonance imaging scanner. Shear wave propagation was imaged and shear stiffness was reconstructed using matched filtering stiffness inversion algorithms.

FINDINGS

The gel phantom imaging and finite element calculation experiments supported our hypothesis that taut bands can be imaged based on its outstanding shear stiffness. The preliminary human study showed a statistically significant 50-100% (P=0.01) increase of shear stiffness in the taut band regions of the involved subjects relative to that of the controls or in nearby uninvolved muscle.

INTERPRETATION

This study suggests that magnetic resonance elastography may have a potential for objectively characterizing myofascial taut bands that have been up to now detectable only by the clinician's fingers.

[Elastosonography of thyroid lesions]

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Diffraction-biased shear wave fields generated with longitudinal magnetic resonance elastography drivers

Magnetic resonance elastography (MRE) is a technique for quantifying the acoustic response of biological tissues to propagating waves applied at low frequencies in order to evaluate mechanical properties. Application-specific MRE drivers are typically required to effectively deliver shear waves within the tissue of interest. Surface MRE drivers with transversely oriented vibrations have often been used to directly generate shear waves. These drivers may have disadvantages in certain applications, such as poor penetration depth and inflexible orientation. Therefore, surface MRE drivers with longitudinally oriented vibrations are used in some situations. The purpose of this work was to investigate and optimize a longitudinal driver system for MRE applications. A cone-like hemispherical distribution of shear waves being generated by these drivers and the wave propagation being governed by diffraction in the near field are shown. Using MRE visualization of the vector displacement field, we studied the properties of the shear wave field created by longitudinal MRE drivers of various sizes to identify optimum shear wave imaging planes. The results offer insights and improvements in both experimental design and imaging plane selection for 2-D MRE data acquisition.

Characterization of the dynamic shear properties of hyaline cartilage using high-frequency dynamic MR elastography

This work evaluated the feasibility of dynamic MR Elastography (MRE) to quantify structural changes in bovine hyaline cartilage induced by selective enzymatic degradation. The ability of the technique to quantify the frequency-dependent response of normal cartilage to shear in the kilohertz range was also explored. Bovine cartilage plugs of 8 mm in diameter were used for this study. The shear stiffness (mu(s)) of each cartilage plug was measured before and after 16 hr of enzymatic treatments by dynamic MRE at 5000 Hz of shear excitation. Collagenase and trypsin were used to selectively affect the collagen and proteoglycans contents of the matrix. Additionally, normal cartilage plugs were tested by dynamic MRE at shear-excitations of 3000-7000 Hz. Measured micro(s) of cartilage plugs showed a significant decrease (-37%, P < 0.05) after collagenase treatment and a significant decrease (-28%, P < 0.05) after trypsin treatment. Furthermore, a near-linear increase (R(2) = 0.9141) in the speed of shear wave propagation with shear-excitation frequency was observed in cartilage, indicating that wave speed is dominated by viscoelastic effects. These experiments suggest that dynamic MRE can provide a sensitive quantitative tool to characterize the degradation process and viscoelastic behavior of cartilage.

Magnetic resonance elastography of the brain

The purpose of this study was to obtain normative data using magnetic resonance elastography (MRE) (a) to obtain estimates of the shear modulus of human cerebral tissue in vivo and (b) to assess a possible age dependence of the shear modulus of cerebral tissue in healthy adult volunteers. MR elastography studies were performed on tissue-simulating gelatin phantoms and 25 healthy adult volunteers. The data were analyzed using spatiotemporal filters and a local frequency estimating algorithm. Statistical analysis was performed using a paired t-test. The mean shear stiffness of cerebral white matter was 13.6 kPa (95% CI 12.3 to 14.8 kPa); while that of gray matter was lower at 5.22 kPa (95% CI 4.76 to 5.66 kPa). The difference was statistically significant (p<0.0001).

Shear modulus reconstruction by ultrasonically measured strain ratio

PURPOSE

In addition to a description of our three previously developed one-dimensional (1D) methods from the viewpoint of shear modulus reconstruction using the strain ratio, two new methods for stabilizing the 1D methods are described, together with their limitations. As confirmed using human in vivo breast tissues, method 1 for evaluating the strain ratio itself is useful when the measurement accuracy of the strain distribution is high. However, because tissues having high shear moduli, such as scirrhous carcinoma, often form singular points/regions, both methods 2 and 3 using the strain ratio (initial estimate) and a regularization method are effective for realizing a unique, stable, useful shear modulus reconstruction. Because method 3 carries out implicit integration only at singular points/regions, whereas method 2 carries out implicit integration throughout the region of interest (ROI), the smaller number of singular points enables more rapid shear modulus reconstruction by method 3 than by method 2. Like method 1, method 3 is also useful when the measurement accuracy of the strain distribution is high. However, when evaluating strain distribution in an ROI with a high spatial resolution to obtain a shear modulus reconstruction having a high spatial resolution, shear modulus reconstructions obtained by methods 1, 2, and 3 often become laterally unstable due to the instability and low accuracy of the strains in the reference regions (reference strains), i.e., regularization in methods 2 and 3 cannot reduce the instability in the initial estimate.

METHODS

To cope with this instability, (i) the reconstruction obtained by calculating the strain ratio should be low-pass filtered; for breast tissues, in particular, the reconstruction of the inverse shear modulus should be low-pass filtered, not the reconstruction of the shear modulus. (ii) Otherwise, when using homogeneous regions as a reference, such as a block of reference material, fatty tissue, or parenchyma, evaluation of the reference strains with a low spatial resolution is effective.

RESULTS

Although such evaluation yields a stable reconstruction with a high spatial resolution compared with that obtained by the low-pass filtering of the strain ratio, we confirmed through simulations that, when reducing artifacts due to a 1D reconstruction of the shear modulus, the evaluation yields a low-accuracy reconstruction value of inhomogeneity. In contrast, in such a case the low-pass filtering of the strain ratio yields a more accurate reconstruction value.

CONCLUSION

All the above-mentioned methods using the strain ratio realize real-time shear modulus reconstruction and should be selected appropriately in conventional ultrasonic imaging equipment by considering the application of the reconstruction (i.e., in accordance with the measurement accuracy of the strains and the occurrence of artifacts).

Probing elastic modulus and depth of bottom-supported inclusions in model tissues using piezoelectric cantilevers

We have experimentally investigated the depth sensitivity limit of a piezoelectric cantilever tissue elastic modulus sensor and simultaneously determined the elastic modulus and the depth of a tumor directly. Using model tissues consisting of bottom-supported modeling clay inclusions of various depths in a gelatin matrix, we empirically determined that the depth sensitivity limit of a piezoelectric cantilever sensor was twice the linear dimension of the indentation area (or the cantilever width). Knowing the depth sensitivity limit of the individual cantilever sensor as input and treating a model tissue that has the gelatin matrix on top and the modeling clay inclusion at the bottom as two springs in series, we showed that the elastic moduli and depths of the hard inclusions could be simultaneously determined with the elastic modulus profiles measured by two cantilevers with different widths as input.

Ultrasonic axial strain measurement for lateral tissue deformation

An axial strain measurement technique and a one-dimensional (1D) shear modulus reconstruction technique were developed previously by using the multidimensional radio-frequency (RF) echo phase matching method and an axial strain ratio, respectively. In this study, these techniques have been applied using a conventional ultrasound (US) imaging system with the constraint that the tissue deforms predominantly in the lateral direction, orthogonal to the ultrasound beam axis. Conventionally, axial strain measurement and axial strain ratio are used when the tissue deforms predominantly in the axial direction by extracorporeally applied pressure or vibration. In any case, an axial strain can be accurately measured using the multidimensional RF-echo phase matching method; such a measurement will be useful and will enable a simple reconstruction in a lateral deformation case. The usefulness of these techniques is demonstrated by agar phantom experiments; several problems related to their use in cases such as accuracy, bias error and detectability of inhomogeneity (contrast-to-noise ratio) are addressed. These techniques will be effective for deep regions-of-interest (ROIs) such as liver tissues, which are inaccessible from the body surface and normally deformed by heart motion or pulsation. Moreover, such techniques will enable the evaluation of the elasticity of various tissues under normal motion such as the arm and leg muscles during exercise.

Effective shear modulus reconstruction obtained with approximate mean normal stress remaining unknown

We previously reported Methods A and B for reconstructing tissue shear modulus and density using mean normal stress as an unknown. The use of Method A enables us to obtain such reconstructions with the mean normal stress remaining unknown by using an iterative method to solve algebraic equations. However, Method A results in a low convergence speed and a low reconstruction accuracy compared with Method B that enables a reconstruction of mean normal stress together. Thus, in this report, we describe a new, rapid and accurate method, Method C, that enables the reconstructions of shear modulus and density in real time with a higher accuracy than Method A. In Method A, no reference mean normal stress is used. In Method C, an arbitrary finite value is used as a quasireference mean normal stress at an arbitrary point (i.e., a quasireference point) or an arbitrary region (i.e., a quasireference region) in the region of interest on the basis of the fact that the gradient operator implemented on the mean normal stress becomes positive-definite. When a quasireference region can be realized, Method C enables such reconstructions with a high accuracy and a high convergence speed similar to Method B. The effectiveness of Method C was verified using simulated phantom deformation data. Method C must be used instead of Method A as a practical method, in combination with Method B.

[STEAM-sequence with multi-echo-readout for static magnetic resonance elastography]

In static magnetic resonance elastography, the elasticity of an object is determined by measuring the internal displacement between two compression states. To reduce signal loss during the long time delay between application of external deformation and the static compression state, a STEAM sequence with a long mixing time is used This results in long scan times. The aim of this work was the development of a STEAM sequence with a multi-echo-readout, which allows the reduction of scan time and number of necessary external deformations. This new sequence was compared to the standard STEAM sequence on an agarose gel phantom with a hard inclusion. In addition, the elasticity of thermal tissue lesions was investigated, which were induced using high-intensity focused ultrasound (HIFU). During a given measurement time, more acquisitions per image can be taken using the multi-echo-readout. As a result the signal-to-noise ratio is increased and errors in the data become clearly smaller. Drawbacks of. the new sequence are its higher signal loss due to T2-decay and its greater sensitivity against ghosting artefacts caused by k-space segmentation. During the investigation of the thermally-induced lesions, a clear contrast in elasticity between normal tissue and the treated region was observed. Taking advantage of the greater accuracy of the new STEAM sequence, it was shown, that this contrast is significantly larger than the one in conventional MR parameters.

Transient elastography using impulsive ultrasound radiation force: a preliminary comparison with surface palpation elastography

The use of impulsive acoustic radiation force for transient strain imaging was investigated and compared with conventional elastography. A series of experiments were performed to evaluate the performances of the technique on gelatine phantoms containing inclusions and to determine a range of applications where radiation force elastography may be useful compared with static elastography. Slip boundaries and cylindrical inclusions of varying elastic modulus were placed in background materials. A focused ultrasound transducer was used to apply localised radiation force to a small volume of tissue mimic (100 mm3) for durations of 8 ms. A conventional real-time ultrasound imaging probe was used to obtain radio- frequency echo signals. The resulting strains were mapped using ultrasound correlation-based methods. The instantaneous strain immediately following cessation of the radiation force was observed at depth within homogeneous gels and within stiff inclusions. The highly localised and transient strain that is produced at depth permits the sensing of variations in tissue elastic properties that are difficult to detect with conventional elastography, due to greater independence from boundary conditions. In particular, radiation force elastograms were more homogeneous in the background and within the inclusions and displayed a superior contrast-transfer-efficiency, particularly for regions that had negative modulus contrast or that were disconnected from the background or the anterior medium by a low friction boundary.

Imaging tumor microenvironment with ultrasound

Recent advances in molecular biology are providing new opportunities for breast cancer imaging. Our approach uses ultrasound to image viscoelastic features of tumors. These features describe microenvironmental factors that stimulate signaling pathways in tumors that ultimately affect metastatic potential and response to traditional therapeutics. This paper explains the motivation for the approach, describes measurements in phantoms and patients, and defines measurement sensitivity using hydrogels with tissue-like features.

Comparison of Motion Encoding Waveforms for Magnetic Resonance Elastography at 3T

Magnetic resonance (MR) elastography has the ability to combine the inherent soft-tissue contrast of traditional MR imaging with quantitative maps of tissue stiffness. Mechanical properties of tissues can vary greatly with disease and degeneration, and can illuminate structure-function understanding of tissues. Dynamic MR elastography is a phase contrast-based method for imaging the transmission of strain waves in an object. The present study evaluates the theoretical and empirical results of using trapezoidal and sinusoidal motion encoding gradients (MEGs) for the purposes of elastography at 3T. The study evaluated the phase-to-noise ratio for the methods, and found excellent agreement between the theoretical predictions and experimental results. The sinusoidal MEGs were predicted to have a relative PNR decrease of 21.5%, which compares very well with the experimental PNR decrease of 19.1% (95% CI = 17.1% to 21.0%). These results show the trapezoidal MEGs provide more sensitivity to strain wave transmission for the purposes of MR elastography.

Mechanical shear wave induced by piezoelectric ceramics for magnetic resonance elastography

Magnetic resonance elastography (MRE) is a noninvasive technique to measure elasticity of tissues in vivo. For MRE, an additional actuator is needed to be mounted on an observed object, and to excite the object. In this paper, an experiment is set to obtain MR mechanical shear wave images. A novel actuator is proposed to generate mechanical wave propagating inside a gel phantom. The actuator is made of piezoelectric ceramics, and is fixed on a plexiglass bracket. Both of the gel phantom and the actuator are put into a head coil in the scanner's bore. The actuator works synchronously with an imaging sequence running on the scanner. The sequence is modified from a FLASH sequence, into a motion-sensitizing phase-contrast sequence, for shear wave imaging. Wave images are presented to show the effect of those factors, such as the stiffness of the phantoms, the frequency of the actuator, the parameters of the motion-sensitizing gradient, and the oscillation of the patient bed.

Normal and shear strain estimation using beam steering on linear-array transducers

In current ultrasound elastography, only the axial component of the displacement vector is estimated and used to produce strain images. A method was recently proposed by our group to estimate both the axial and lateral components of a displacement vector following a uniaxial compression. Previous work evaluated the technique using both simulations and a mechanically translated phased array transducer. In this paper, we present initial results using beam steering on a linear array transducer attached to a commercial scanner to acquire echo signals for estimating 2-D displacement vectors. Single-inclusion and anthropomorphic breast phantoms with different boundary properties between the inclusion and background material are imaged by acquiring echo data along beam lines ranging from -15 degrees to 15 degrees relative to the compression direction. 1-D cross-correlation is used to calculate "angular displacements" in each acquisition direction, yielding axial and lateral components of the displacement vector. Strain tensor components are estimated from these displacements. Features on shear strain images generated for the inclusion phantom agree with those predicted using FEA analysis. Experimental results demonstrate the utility of this technique on clinical scanners. Shear strain tensors obtained using this method may provide useful information for the differentiation of benign from malignant tumors. For the linear array transducer used in this study, the optimum angular increment is around 3 degrees. However, more work is required for the selection of an appropriate value for the maximum beam angle for optimal performance of this technique.

Reconstructions of shear modulus, Poisson's ratio, and density using approximate mean normal stress lambda epsilon alpha alpha as unknown

As a differential diagnosis technique for living soft tissues, we are developing ultrasonic-strain-measurement-based shear modulus reconstruction methods. Previously, we reported three-dimensional (3-D) and 2-D reconstruction methods utilizing a typical Poisson's ratio very close to 0.5 (nearly-incompressible). However, because a decrease in the accuracy of the reconstructed value was confirmed to be due to the difference between the original value and the set value, we proposed 3-D and 2-D methods of reconstructing Poisson's ratio as well. Furthermore, we proposed methods of reconstructing density and dealing with dynamic deformation. However, due to tissue incompressibility, the reconstructions of shear modulus, Poisson's ratio, and density became unstable. In this report, to obtain stable, unique reconstructions, we describe a new reconstruction method using mean normal stress approximated by the product of one of Lame's constants X and volume strain epsilon alpha alpha as an unknown. Regularization is simultaneously applied to the respective distributions to decrease the instability of the reconstructions due to measurement errors of the deformation. This method also enables stable, unique reconstructions of shear modulus and density under the condition that the mean normal stress remains unknown. We also verify the effectiveness of this method through 3-D simulations, while showing erroneous artifacts occurring when 2-D and 1-D reconstructions are performed.

Real-time sonoelastography performed in addition to B-mode ultrasound and mammography: improved differentiation of breast lesions?

RATIONALE AND OBJECTIVES

The goal of the present study was to compare the sensitivity and specificity of elastography with that of B-mode ultrasound (US) and mammography.

MATERIALS AND METHODS

A total of 300 patients with histologically confirmed breast lesions (168 benign, 132 malignant) were included. Evaluation was by means of the three-dimensional finite-element method. The data are color-coded and superimposed on the B-mode US scan. The images were evaluated by two independent readers. The results were compared with mammography, histology, and the data obtained by previous US investigations. Sensitivities and specificities were calculated.

RESULTS

Sensitivity and specificity in the differentiation of benign and malignant lesions were 87% and 85%, respectively, for mammography and 94% and 83% for B-mode US. The two examiners were in very good agreement in their evaluation of the elastograms (kappa: 0.86). Elastography had a sensitivity of 82% and a specificity of 87%. Elastography was superior to B-mode US in diagnosing Breast Imaging Reporting and Data System (BI-RADS) 3 lesions (92% vs. 82% specificity) and in lipomatous involution (80% vs. 69% specificity).

CONCLUSION

Elastography in breast lesions showed a higher specificity and a lower sensitivity in comparison with B-mode sonography. Elastography may be beneficial in BI-RADS 3 lesions and in lipomatous involution.

OCT-based elastography for large and small deformations

We present two approaches to speckle tracking for optical coherence tomography (OCT)-based elastography, one appropriate for small speckle motions and the other for large, rapid speckle motions. Both approaches have certain advantages over traditional cross-correlation based motion algorithms. We apply our algorithms to quantifying the strain response of a mechanically inhomogeneous, bi-layered polyvinyl alcohol tissue phantom that is subjected to either small or large dynamic compressive forces while being imaged with a spectral domain OCT system. In both the small and large deformation scenarios, the algorithms performed well, clearly identifying the two mechanically disparate regions of the phantom. The stiffness ratio between the two regions was estimated to be the same for the two scenarios and both estimates agreed with the expected stiffness ratio based on earlier mechanical testing. No single numerical approach is appropriate for all cases and the experimental conditions dictate the proper choice of speckle shift algorithm for OCT-based elastography studies.

Dynamic mechanical response of elastic spherical inclusions to impulsive acoustic radiation force excitation

Acoustic radiation force impulse imaging has been used clinically to study the dynamic response of lesions relative to their background material to focused, impulsive acoustic radiation force excitations through the generation of dynamic displacement field images. Dynamic displacement data are typically displayed as a set of parametric images, including displacement immediately after excitation, maximum displacement, time to peak displacement, and recovery time from peak displacement. To date, however, no definitive trends have been established between these parametric images and the tissues' mechanical properties. This work demonstrates that displacement magnitude, time to peak displacement, and recovery time are all inversely related to the Young's modulus in homogeneous elastic media. Experimentally, pulse repetition frequency during displacement tracking limits stiffness resolution using the time to peak displacement parameter. The excitation pulse duration also impacts the time to peak parameter, with longer pulses reducing the inertial effects present during impulsive excitations. Material density affects tissue dynamics, but is not expected to play a significant role in biological tissues. The presence of an elastic spherical inclusion in the imaged medium significantly alters the tissue dynamics in response to impulsive, focused acoustic radiation force excitations. Times to peak displacement for excitations within and outside an elastic inclusion are still indicative of local material stiffness; however, recovery times are altered due to the reflection and transmission of shear waves at the inclusion boundaries. These shear wave interactions cause stiffer inclusions to appear to be displaced longer than the more compliant background material. The magnitude of shear waves reflected at elastic lesion boundaries is dependent on the stiffness contrast between the inclusion and the background material, and the stiffness and size of the inclusion dictate when shear wave reflections within the lesion will interfere with one another. Jitter and bias associated with the ultrasonic displacement tracking also impact the estimation of a tissue's dynamic response to acoustic radiation force excitation.

Dynamic MRS and MRI of skeletal muscle function and biomechanics

MR is a powerful technique for studying the biomechanical and functional properties of skeletal muscle in vivo in health and disease. This review focuses on 31P, 1H and 13C MR spectroscopy for assessment of the dynamics of muscle metabolism and on dynamic 1H MRI methods for non-invasive measurement of the biomechanical and functional properties of skeletal muscle. The information thus obtained ranges from the microscopic level of the metabolism of the myocyte to the macroscopic level of the contractile function of muscle complexes. The MR technology presented plays a vital role in achieving a better understanding of many basic aspects of muscle function, including the regulation of mitochondrial activity and the intricate interplay between muscle fiber organization and contractile function. In addition, these tools are increasingly being employed to establish novel diagnostic procedures as well as to monitor the effects of therapeutic and lifestyle interventions for muscle disorders that have an increasing impact in modern society.

Phenomenological model of diffuse global and regional atrophy using finite-element methods

The main goal of this work is the generation of ground-truth data for the validation of atrophy measurement techniques, commonly used in the study of neurodegenerative diseases such as dementia. Several techniques have been used to measure atrophy in cross-sectional and longitudinal studies, but it is extremely difficult to compare their performance since they have been applied to different patient populations. Furthermore, assessment of performance based on phantom measurements or simple scaled images overestimates these techniques' ability to capture the complexity of neurodegeneration of the human brain. We propose a method for atrophy simulation in structural magnetic resonance (MR) images based on finite-element methods. The method produces cohorts of brain images with known change that is physically and clinically plausible, providing data for objective evaluation of atrophy measurement techniques. Atrophy is simulated in different tissue compartments or in different neuroanatomical structures with a phenomenological model. This model of diffuse global and regional atrophy is based on volumetric measurements such as the brain or the hippocampus, from patients with known disease and guided by clinical knowledge of the relative pathological involvement of regions and tissues. The consequent biomechanical readjustment of structures is modelled using conventional physics-based techniques based on biomechanical tissue properties and simulating plausible tissue deformations with finite-element methods. A thermoelastic model of tissue deformation is employed, controlling the rate of progression of atrophy by means of a set of thermal coefficients, each one corresponding to a different type of tissue. Tissue characterization is performed by means of the meshing of a labelled brain atlas, creating a reference volumetric mesh that will be introduced to a finite-element solver to create the simulated deformations. Preliminary work on the simulation of acquisition artefacts is also presented. Cross-sectional and longitudinal sets of simulated data are shown and a visual classification protocol has been used by experts to rate real and simulated scans according to their degree of atrophy. Results confirm the potential of the proposed methodology.

Imaging the mechanical stiffness of skin lesions by in vivo acousto-optical elastography

Optical elastography is an imaging modality that relies on variations in the local mechanical properties of biological tissues as the contrast mechanism for image formation. Skin lesions, such as melanomas and other invasive conditions, are known to alter the arrangement of collagen fibers in the skin and thus should lead to alterations in local skin mechanical properties. We report on an acousto-optical elastography (AOE) imaging modality for quantifying the mechanical behavior of skin lesions. The method relies upon stimulating the tissue with a low frequency acoustic force and imaging the resulting strains in the tissue by means of quantifying the magnitude of the dynamic shift in a back-reflected laser speckle pattern from the skin. The magnitude of the shift reflects the local stiffness of the tissue. We demonstrate AOE on a tissue-mimicking phantom, an in vivo mouse melanoma lesion and two types of in vivo human melanocytic nevi. The skin lesions we examined were found to have distinct mechanical properties that appear to correlate with the varying degrees of dermal involvement of the lesions.

Prostate mechanical imaging: 3-D image composition and feature calculations

We have developed a method and a device entitled prostate mechanical imager (PMI) for the real-time imaging of prostate using a transrectal probe equipped with a pressure sensor array and position tracking sensor. PMI operation is based on measurement of the stress pattern on the rectal wall when the probe is pressed against the prostate. Temporal and spatial changes in the stress pattern provide information on the elastic structure of the gland and allow two-dimensional (2-D) and three-dimensional (3-D) reconstruction of prostate anatomy and assessment of prostate mechanical properties. The data acquired allow the calculation of prostate features such as size, shape, nodularity, consistency/hardness, and mobility. The PMI prototype has been validated in laboratory experiments on prostate phantoms and in a clinical study. The results obtained on model systems and in vivo images from patients prove that PMI has potential to become a diagnostic tool that could largely supplant DRE through its higher sensitivity, quantitative record storage, ease-of-use and inherent low cost.

Ultrasonic tracking of acoustic radiation force-induced displacements in homogeneous media

The use of ultrasonic methods to track the tissue deformation generated by acoustic radiation force is subject to jitter and displacement underestimation errors, with displacement underestimation being primarily caused by lateral and elevation shearing within the point spread function (PSF) of the ultrasonic beam. Models have been developed using finite element methods and Field II, a linear acoustic field simulation package, to study the impact of focal configuration, tracking frequency, and material properties on the accuracy of ultrasonically tracking the tissue deformation generated by acoustic radiation force excitations. These models demonstrate that lateral and elevation shearing underneath the PSF of the tracking beam leads to displacement underestimation in the focal zone. Displacement underestimation can be reduced by using tracking beams that are narrower than the spatial extent of the displacement fields. Displacement underestimation and jitter decrease with time after excitation as shear wave propagation away from the region of excitation reduces shearing in the lateral and elevation dimensions. The use of higher tracking frequencies in broadband transducers, along with 2D focusing in the elevation dimension, will reduce jitter and improve displacement tracking accuracy. Relative displacement underestimation remains constant as a function of applied force, whereas jitter increases with applied force. Underdeveloped speckle (SNR < 1.91) leads to greater levels of jitter and peak displacement underestimation. Axial shearing is minimal over the tracking kernel lengths used in acoustic radiation force impulse imaging and thus does not impact displacement tracking.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Optical coherence elastography of engineered and developing tissue

Biomechanical elastic properties are among the many variables used to characterize in vivo and in vitro tissues. Since these properties depend largely on the micro- and macroscopic structural organization tissue, it is crucial to understand the mechanical properties and the alterations that occur tissues respond to external forces or to disease processes. Using a novel technique called coherence elastography (OCE), we mapped the spatially distributed mechanical displacements strains in a representative model of a developing, engineered tissue as cells began to proliferate attach within a three-dimensional collagen matrix. OCE was also performed in the complex tissue of the Xenopus laevis (African frog) tadpole. Displacements were quantified a cross-correlation algorithm on pre- and postcompression images, which were acquired using coherence tomography (OCT). The images of the engineered tissue were acquired over a 10-development period to observe the relative strain differences in various regions. OCE was able differentiate changes in strain over time, which corresponded with cell proliferation and matrix as confirmed with histological observations. By anatomically mapping the regional variation stiffness with micron resolution, it may be possible to provide new insight into the complex by which engineered and natural tissues develop complex structures.

A review of breast ultrasound

Frequent advances in transducer design, electronics, computers, and signal processing have improved the quality of ultrasound images to the extent that sonography is now a major mode of imaging for the clinical diagnosis of breast cancer. Breast ultrasound is routinely used for differentiating cysts and solid nodules with high specificity. In combination with mammography, ultrasound is used to characterize solid masses as benign or malignant. There is growing interest in using Doppler ultrasound and contrast agents for measuring tumor blood flow and for imaging tumor vascularity. Ease of use and real-time imaging capability make breast ultrasound a method of choice for guiding breast biopsies and other interventional procedures. Breast ultrasound is used in many forms. B-mode is the most common form of imaging for the breast, although compound imaging and harmonic imaging are being increasingly applied to better visualize breast lesions and to reduce image artifacts. These developments, together with the formulation of a standardized lexicon of solid mass features, have improved the diagnostic performance of breast ultrasound. Several approaches that are currently being investigated to further improve performance include: (1) computer-aided-diagnosis; (2) the assessment of tumor vascularity and tumor blood flow with Doppler ultrasound and contrast agents; and (3) tissue elasticity imaging. In the future, ultrasound will play a greater role in differentiating benign from malignant masses and in the diagnosis of breast cancer.

Towards an acoustic model-based poroelastic imaging method: I. Theoretical foundation

The ultrasonic measurement and imaging of tissue elasticity is currently under wide investigation and development as a clinical tool for the assessment of a broad range of diseases, but little account in this field has yet been taken of the fact that soft tissue is porous and contains mobile fluid. The ability to squeeze fluid out of tissue may have implications for conventional elasticity imaging, and may present opportunities for new investigative tools. When a homogeneous, isotropic, fluid-saturated poroelastic material with a linearly elastic solid phase and incompressible solid and fluid constituents is subjected to stress, the behaviour of the induced internal strain field is influenced by three material constants: the Young's modulus (E(s)) and Poisson's ratio (nu(s)) of the solid matrix and the permeability (k) of the solid matrix to the pore fluid. New analytical expressions were derived and used to model the time-dependent behaviour of the strain field inside simulated homogeneous cylindrical samples of such a poroelastic material undergoing sustained unconfined compression. A model-based reconstruction technique was developed to produce images of parameters related to the poroelastic material constants (E(s), nu(s), k) from a comparison of the measured and predicted time-dependent spatially varying radial strain. Tests of the method using simulated noisy strain data showed that it is capable of producing three unique parametric images: an image of the Poisson's ratio of the solid matrix, an image of the axial strain (which was not time-dependent subsequent to the application of the compression) and an image representing the product of the aggregate modulus E(s)(1-nu(s))/(1+nu(s))(1-2nu(s)) of the solid matrix and the permeability of the solid matrix to the pore fluid. The analytical expressions were further used to numerically validate a finite element model and to clarify previous work on poroelastography.

Stiffness-weighted magnetic resonance imaging

An imaging method is introduced in which the signal in MR images is affected by the stiffness distribution in the object being imaged. Intravoxel phase dispersion (IVPD) that occurs during MR elastography (MRE) acquisitions decreases the signal in soft regions more than in stiff regions due to changes in shear wave amplitude and wavelength. The IVPD effect is enhanced by lowpass filtering the MR k-space data with a circular Gaussian lowpass filter. A processing method is introduced to take the time series of MRE magnitude images with IVPD and produce a final stiffness-weighted image (SWI) by calculating the minimum signal at each pixel from a small number of temporal samples. The SWI technique is demonstrated in phantom studies as well as in the case of a preserved postmortem breast tissue specimen with a stiff lesion created by focused ultrasound ablation to mimic a breast cancer. When free of significant sources of depth-dependent wave attenuation, interference, and boundary effects, SWI is a simple, fast, qualitative technique that does not require the use of phase unwrapping or inversion algorithms for localizing stiff regions in an object.

Elastography for breast cancer diagnosis using radiation force: system development and performance evaluation

The use of impulsive acoustic radiation force for strain imaging was investigated. A focused ultrasound transducer was used to apply localized radiation force to a small volume of tissue mimic (100 mm3) for durations of 8 ms. A conventional real-time ultrasound imaging probe was used to obtain echo signals. The resulting strains were mapped using ultrasound correlation-based methods. The instantaneous strain immediately following cessation of the radiation force was observed at depth within homogeneous gels and within stiff inclusions, and was seen to vary approximately linearly with Young's modulus of the material. The highly localized and transient strain that is produced may permit the sensing of variations in tissue elastic properties that are difficult to detect with conventional elastography because of greater independence from boundary conditions. For example, the characteristic, bi-directional, high strain artefacts attributable to stress concentration, often seen with static elastography at tissue-inclusion interfaces, do not appear using the transient radiation force strain imaging technique.

Young's modulus reconstruction of vulnerable atherosclerotic plaque components using deformable curves

Rupture, with subsequent thrombosis, of thin-cap fibroatheromas (TCFAs) is a major cause of myocardial infarction. A TCFA has two main components: these are a large, soft lipid pool and a thin, stiff fibrous cap covering it. Quantification of their morphology and stiffness is essential for monitoring atherosclerosis and quantifying the effect of plaque-stabilizing pharmaceutical treatment. To accomplish this, we have developed a model-based Young's modulus reconstruction method. From a plaque strain elastogram, measured with an intravascular ultrasound catheter, it reconstructs a Young's modulus image of the plaque. To this end, a minimization algorithm automatically varies the morphology and stiffness parameters of a TCFA computer model, until the corresponding computer-simulated strain elastogram resembles the measured strain elastogram. The morphology parameters of the model are the control-points of two deformable Bézier curves; one curve delineates the distal border of the lipid pool region, the other the distal border of the cap region. These component regions are assumed to be homogeneous and their stiffness is characterized by a Young's modulus. Reconstructions from strain elastograms that were 1. simulated using a histology-derived computer TCFA, 2. measured from a physical phantom with a soft lipid pool, and 3. simulated with a computer TCFA, where the complexity of its plaque component borders was increased, demonstrated the superior reconstruction/delineation behavior of this method, compared with a previously developed circular reconstruction method that used only circles for border delineation. Consequently, this method may become a valuable tool for the quantification of both the morphology and stiffness of vulnerable atherosclerotic plaque components.

Elasto-mammography: Theory, Algorithm, and Phantom Study

A new imaging modality framework, called elasto-mammography, is proposed to generate the elastograms of breast tissues based on conventional X-ray mammography. The displacement information is extracted from mammography projections before and after breast compression. Incorporating the displacement measurement, an elastography reconstruction algorithm is specifically developed to estimate the elastic moduli of heterogeneous breast tissues. Case studies with numerical breast phantoms are conducted to demonstrate the capability of the proposed elasto-mammography. Effects of noise with measurement, geometric mismatch, and elastic contrast ratio are evaluated in the numerical simulations. It is shown that the proposed methodology is stable and robust for characterization of the elastic moduli of breast tissues from the projective displacement measurement.

Rapid MR elastography using selective excitations

Rapid MR elastography (MRE) techniques using spatially-selective excitations to reduce acquisition times to a few seconds or less were devised and tested. The techniques included reduced field of view (rFOV) MRE and 1D MRE (beam MRE) using 2D spatially selective RF excitations for gradient-echo (GRE) applications and intersecting 90 degrees and 180 degrees slice-selective excitations for spin-echo (SE) applications. It was shown that scan times could be reduced by a factor of 8 using rFOV MRE, and by 64 using beam MRE, while still obtaining stiffness estimates comparable to full-FOV MRE. Results were shown in gel phantom experiments as well as in the case of a preserved postmortem breast tissue specimen with a stiff lesion. These methods can be used to more rapidly interrogate regions of interest (ROIs) in tissue to quickly obtain information about the viscoelastic properties of that tissue.

Analysis of contrast in images generated with transient acoustic radiation force

Several mechanical imaging methods are under investigation that use focused ultrasound (US) as a source of mechanical excitation. Images are then generated of the tissue response to this localized excitation. One such method, acoustic radiation force impulse (ARFI) imaging, utilizes a single US transducer on a commercial US system to transmit brief, high-energy, focused acoustic pulses to generate radiation force in tissue and correlation-based US methods to detect the resulting tissue displacements. Local displacements reflect relative mechanical properties of tissue. The resolution of these images is comparable with that of conventional B-mode imaging. The response of tissue to focused radiation force excitation is complex and depends upon tissue geometry, forcing function geometry (i.e., region of excitation, or ROE) and tissue mechanical and acoustic properties. Finite element method (FEM) simulations using an experimentally validated model and phantom experiments have been performed using varying systems, system configurations and tissue-mimicking phantoms to determine their impact on image quality. Image quality is assessed by lesion contrast. Due to the dynamic nature of ARFI excitation, lesion contrast is temporally-dependent. Contrast of spherical inclusions is highest immediately after force cessation, decreases with time postforce and then reverses, due to shear wave interaction with internal boundaries, differences in shear modulus between lesions and background and inertial effects. In images generated immediately after force cessation, contrast does not vary with applied force, increases with lesion stiffness and increases as the ROE size decreases relative to the size of the structure being imaged. These studies indicate that improved contrast in radiation force-generated images will be achieved as ROE size decreases; however, frame rate and thermal considerations present trade-offs with small ROE size.

Application of soft tissue modelling to image-guided surgery

The deformation of soft tissue compromises the accuracy of image-guided surgery based on preoperative images, and restricts its applicability to surgery on or near bony structures. One way to overcome these limitations is to combine biomechanical models with sparse intraoperative data, in order to realistically warp the preoperative image to match the surgical situation. We detail the process of biomechanical modelling in the context of image-guided surgery. We focus in particular on the finite element method, which is shown to be a promising approach, and review the constitutive relationships which have been suggested for representing tissue during surgery. Appropriate intraoperative measurements are required to constrain the deformation, and we discuss the potential of the modalities which have been applied to this task. This technology is on the verge of transition into clinical practice, where it promises to increase the guidance accuracy and facilitate less invasive interventions. We describe here how soft tissue modelling techniques have been applied to image-guided surgery applications.

Tissue-mimicking agar/gelatin materials for use in heterogeneous elastography phantoms

Five 9 cm x 9 cm x 9 cm phantoms, each with a 2-cm-diameter cylindrical inclusion, were produced with various dry-weight concentrations of agar and gelatin. Elastic contrasts ranged from 1.5 to 4.6, and values of the storage modulus (real part of the complex Young's modulus) were all in the soft tissue range. Additives assured immunity from bacterial invasion and can produce tissue-mimicking ultrasound and NMR properties. Monitoring of strain ratios over a 7 to 10 month period indicated that the mechanical properties of the phantoms were stable, allowing about 1 month for the phantom to reach chemical equilibrium. The only dependable method for determining the storage moduli of the inclusions is to make measurements on samples excised from the phantoms. If it is desired to produce and accurately characterize a phantom with small inclusions with other shapes, such as an array of small spheres, an auxiliary phantom with the geometry of the cylindrical inclusion phantoms or the equivalent should be made at the same time using the same materials. The elastic contrast can then be determined using samples excised from the auxiliary phantom. A small increase of about 10% in volume of the cylindrical inclusions occurred-a tolerable increase. Interestingly, the smallest increase (about 5%) occurred in the phantom with the largest elastic contrast.

Magnetic resonance elastography of the breast: correlation of signal intensity data with viscoelastic properties

OBJECTIVES

We sought to investigate the potential value of magnetic resonance (MR) elastography to improve the differentiation between benign and malignant tumors.

MATERIAL AND METHODS

Measurements of 5 patients with 6 malignant lesions, 11 patients with benign lesions, and 4 patients with no lesions at all were performed at 1.5 Tesla. After breast MR imaging, MR elastography was performed as a targeted measurement. Low-frequency mechanical waves (65 Hz) were transmitted into the breast tissue using an oscillator and were displayed by means of a MR sequence within the phase of the MR image. After reconstruction, the viscoelastic information was correlated with the signal intensity and morphology data.

RESULTS

All examinations were technically successful realized in approximately 25 minutes. Malignant tumors documented higher values of elasticity than benign corresponding with signal intensity and morphologic data.

CONCLUSION

A good separation exists between benign and malignant lesions in elasticity, corresponding with specific signal intensity and morphologic data. Further clinical studies with a larger number of patients are needed for extended validation.

Tomography-based 3-D anisotropic elastography using boundary measurements

While ultrasound- and magnetic resonance-based elastography techniques have proved to be powerful biomedical imaging tools, most approaches assume isotropic material properties. In this paper, a general framework is developed for tomography-based anisotropic elastography. An anatomically well-motivated piece-wise homogeneous model is proposed to represent a class of biological objects consisting of different regions. With established tomography modality, static displacements are measured on the entire external and internal boundaries, and the force distribution is recorded on part of the external surface. A principle is proposed to identify the anisotropic elastic moduli of the constituent regions with the obtained boundary measurements. The reconstruction procedure is optimization-based with minimizing an objective function that measures the difference between the predicted and observed displacements. Analytic gradients of the objective function with respect to the elastic moduli are calculated using an adjoint method, and are utilized to significantly improve the numerical efficiency. Simulations are performed to identify the elastic moduli in a breast phantom consisting of soft tissue and a hard tumor. For isotropic phantom, one set of the boundary measurements enables unique reconstruction results for the tissue and tumor. For anisotropic phantom, however, multiple sets of the measurements corresponding to different deformation modes become necessary.

Modality independent elastography (MIE): potential applications in dermoscopy

The use of palpation information for skin disease characterization is not as commonly used as in other soft tissues, although mechanical differences within lesions have been noted. For example, regions of hyperkeratosis have the potential to transform into cancerous lesions and likely feature different material properties from those of surrounding normal tissue due to varying cytoarchitecture. As a result, the spatial distribution of lesion mechanical properties may serve to assist a diagnosis or enhance visualization of the complete extent of a cancerous region, i.e., accurate information regarding the margins of disease for surgical therapy. In this work, a multiresolution extension to a novel elastographic imaging method called Modality Independent Elastography (MIE) is used to characterize the mechanical properties of a skin-like phantom embedded with a mock stiff lesion. Simulation studies were also performed to investigate the potential for characterizing realistic melanoma lesions. Elasticity image reconstructions from the phantom experiments localized the stiff inclusion and had good correlation between the Young's modulus contrast ratio and experimental measurements from material testing. In addition, multiresolution MIE was shown to be a more robust framework than its single-resolution version. Results from the melanoma simulation demonstrate the potential for using multiresolution MIE with dermoscopic images.

Design, fabrication, and characterization of a tissue-equivalent phantom for optical elastography

We suitably adapt the design of a tissue-equivalent phantom used for photoacoustic imaging to construct phantoms for optical elastography. The elastography phantom we consider should have optical properties such as scattering coefficient, scattering anisotropy factor, and refractive index; mechanical properties such as storage and loss modulus; and acoustic properties such as ultrasound velocity, attenuation coefficient, and acoustic impedance to match healthy and diseased tissues. The phantom is made of poly (vinyl alcohol) (PVA) and its mechanical, optical, and acoustic properties are tailored by physical cross-linking effected through subjecting a suitable mix of PVA stock and water to a number of freeze-thaw cycles and by varying the degree of hydrolysis in the PVA stock. The optical, mechanical, and acoustic properties of the samples prepared are measured by employing different techniques. The measured variations in the values of optical scattering coefficient, scattering anisotropy factor, and refractive index and storage modulus are found to be comparable to those in normal and diseased breast tissues. The acoustic properties such as sound speed, acoustic attenuation coefficient, and density are found to be close to the average values reported in the literature for normal breast tissue.