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Wiskin J, Klock J, Love S. Breast Glandular and Ductal Volume Changes during the Menstrual Cycle: A Study in 48 Breasts Using Ultralow-Frequency Transmitted Ultrasound Tomography/Volography. Tomography 2024; 10:789-805. [PMID: 38787020 PMCID: PMC11125938 DOI: 10.3390/tomography10050060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
The aim of this study was to show for the first time that low-frequency 3D-transmitted ultrasound tomography (3D UT, volography) can differentiate breast tissue types using tissue properties, accurately measure glandular and ductal volumes in vivo, and measure variation over time. Data were collected for 400 QT breast scans on 24 women (ages 18-71), including four (4) postmenopausal subjects, 6-10 times over 2+ months of observation. The date of onset of menopause was noted, and the cases were further subdivided into three (3) classes: pre-, post-, and peri-menopausal. The ducts and glands were segmented using breast speed of sound, attenuation, and reflectivity images and followed over several menstrual cycles. The coefficient of variation (CoV) for glandular tissue in premenopausal women was significantly larger than for postmenopausal women, whereas this is not true for the ductal CoV. The glandular standard deviation (SD) is significantly larger in premenopausal women vs. postmenopausal women, whereas this is not true for ductal tissue. We conclude that ducts do not appreciably change over the menstrual cycle in either pre- or post-menopausal subjects, whereas glands change significantly over the cycle in pre-menopausal women, and 3D UT can differentiate ducts from glands in vivo.
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Affiliation(s)
- James Wiskin
- QT Imaging Holdings, 3 Hamilton Landing, Ste 160, Novato, CA 94949, USA;
| | - John Klock
- QT Imaging Holdings, 3 Hamilton Landing, Ste 160, Novato, CA 94949, USA;
| | - Susan Love
- Dr. Susan Love (Deceased) Fund for Breast Cancer Research, Tower Foundation, c/o C. C. Conway, 8767 Wilshire Boulevard, Suite 401, Beverly Hills, CA 90211, USA
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Littrup PJ, Mehrmohammadi M, Duric N. Breast Tomographic Ultrasound: The Spectrum from Current Dense Breast Cancer Screenings to Future Theranostic Treatments. Tomography 2024; 10:554-573. [PMID: 38668401 PMCID: PMC11053617 DOI: 10.3390/tomography10040044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
This review provides unique insights to the scientific scope and clinical visions of the inventors and pioneers of the SoftVue breast tomographic ultrasound (BTUS). Their >20-year collaboration produced extensive basic research and technology developments, culminating in SoftVue, which recently received the Food and Drug Administration's approval as an adjunct to breast cancer screening in women with dense breasts. SoftVue's multi-center trial confirmed the diagnostic goals of the tissue characterization and localization of quantitative acoustic tissue differences in 2D and 3D coronal image sequences. SoftVue mass characterizations are also reviewed within the standard cancer risk categories of the Breast Imaging Reporting and Data System. As a quantitative diagnostic modality, SoftVue can also function as a cost-effective platform for artificial intelligence-assisted breast cancer identification. Finally, SoftVue's quantitative acoustic maps facilitate noninvasive temperature monitoring and a unique form of time-reversed, focused US in a single theranostic device that actually focuses acoustic energy better within the highly scattering breast tissues, allowing for localized hyperthermia, drug delivery, and/or ablation. Women also prefer the comfort of SoftVue over mammograms and will continue to seek out less-invasive breast care, from diagnosis to treatment.
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Affiliation(s)
- Peter J. Littrup
- Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA; (M.M.); (N.D.)
- Delphinus Medical Technologies, Inc., Novi, MI 48374, USA
| | - Mohammad Mehrmohammadi
- Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA; (M.M.); (N.D.)
| | - Nebojsa Duric
- Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA; (M.M.); (N.D.)
- Delphinus Medical Technologies, Inc., Novi, MI 48374, USA
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Wiskin J, Malik B, Ruoff C, Pirshafiey N, Lenox M, Klock J. Whole-Body Imaging Using Low Frequency Transmission Ultrasound. Acad Radiol 2023; 30:2674-2685. [PMID: 36841742 DOI: 10.1016/j.acra.2023.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 02/26/2023]
Abstract
RATIONALE AND OBJECTIVES To indicate that 3D low-frequency ultrasound tomography with 3D data acquisition (volography) is a safe, low-cost, high-resolution, whole-body meso-scale medical imaging modality that gives high-resolution quantitatively accurate clinically relevant images. MATERIALS AND METHODS We compare the speed of sound accuracy in various organs in situ. We validate our 3D ultrasound tomography images using MRI and gross section anatomy as ground truth in 10-day old piglets. Data acquisition is accomplished with the QT Scanner at ∼1 MHz center frequency, and array transceivers for reflection data @3.6 MHz. Images are generated with unique model-based 3D ultrasound tomography algorithms. In reflection, we use 3D refraction-corrected ray tracing to allow 360° compounding with sub-mm resolution. Four 10-12 day old pigs were anesthetized and whole-body images were acquired via low-frequency transmitted ultrasound and 3T MRI. RESULTS Tissue values were within an average of 1.07% (0.5%) of the literature values. We also show the detailed correlation of our images with MRI images in axial, coronal, and sagittal views. Volography images of a piglet show high resolution and quantitative accuracy, showing more contrast &resolution than 3T MRI, including the kidney showing medulla, cortex and fibrous cover, and small intestines with ileal lumen detail visible. CONCLUSION We establish that 3D ultrasound tomography (volography), yields high-resolution quantitatively accurate images whole-body images in presence of bone and air which are potentially clinically useful but have not appeared in the literature.
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Affiliation(s)
- James Wiskin
- QT Imaging, 3 Hamilton Landing Ste 160, Novato, CA 94949.
| | - Bilal Malik
- QT Imaging, 3 Hamilton Landing Ste 160, Novato, CA 94949
| | - Cathy Ruoff
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | | | - Mark Lenox
- QT Imaging, 3 Hamilton Landing Ste 160, Novato, CA 94949
| | - John Klock
- QT Imaging, 3 Hamilton Landing Ste 160, Novato, CA 94949
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Zhang Q, Liu Q, Liu Z, Ding M, Yuchi M. Effect of spatial-domain pulse width on the resolution of scattering images in ultrasound computed tomography. Phys Med Biol 2023; 68:175008. [PMID: 37494939 DOI: 10.1088/1361-6560/aceace] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023]
Abstract
Full-aperture tomography (FAT) is the major image reconstruction method for a circular ring array (CRA)-based ultrasound computed tomography (USCT) system. The FAT technique requires transferring the reconstruction process from the temporal domain to the spatial domain, during which the imaging resolution of the USCT is degraded by the spatial-domain pulse width (SDPW) of backprojection areas. To tackle this challenge, this study investigates the characteristics of the SDPW and how it degrades the image resolution. We show that the SDPW depends on the frequency of the ultrasound and the position of the transmitting elements, receiving elements and the imaging point. To quantify the deterioration of image resolution associated with the position of the transmitting and receiving elements, a SDPW broadening factor (SDPWBF) is introduced. The results of numerical simulation show a smaller SDPWBFprovides a better reflection image resolution, and the distribution of SDPWBFshows that a shorter distance between the receiving element and the transmitting element yields a smaller SDPWBF. The SDPWBFis therefore able to be an indicator of selecting the signals acquired from the transmitting and receiving elements to perform optimal image resolution. Single-scatterer phantom andinvivoexperiments demonstrate how the SDPWBFaffects the USCT image spatial resolution and signal-to-noise ratio (SNR), and the results agree well with the theoretical predictions.
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Affiliation(s)
- Qiude Zhang
- Biomedical Engineering Department, Huazhong University of Science and Technology, Wuhan 430074, People's Republic of China
| | - Quanquan Liu
- Biomedical Engineering Department, Huazhong University of Science and Technology, Wuhan 430074, People's Republic of China
| | - Zhaohui Liu
- Biomedical Engineering Department, Huazhong University of Science and Technology, Wuhan 430074, People's Republic of China
| | - Mingyue Ding
- Biomedical Engineering Department, Huazhong University of Science and Technology, Wuhan 430074, People's Republic of China
| | - Ming Yuchi
- Biomedical Engineering Department, Huazhong University of Science and Technology, Wuhan 430074, People's Republic of China
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Wiskin J, Malik B, Klock J. Low frequency 3D transmission ultrasound tomography: technical details and clinical implications. Z Med Phys 2023; 33:427-443. [PMID: 37295982 PMCID: PMC10517404 DOI: 10.1016/j.zemedi.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 06/12/2023]
Abstract
A novel 3D ultrasound tomographic (3D UT) method (called volography) that creates a speed of sound (SOS) map and a reflection modality that is co-registered are reviewed and shown to be artifact free even in the presence of high contrast and thus shown to be applicable for breast, orthopedic and pediatric clinical use cases. The 3D UT images are almost isotropic with mm resolution and the reflection image is compounded over 360 degrees to create sub-mm resolution in plane. METHODS The physics of ultrasound scattering requires 3D modeling and the concomitant high computational cost is ameliorated with a bespoke algorithm (paraxial approximation - discussed here) and Nvidia GPUs. The resulting reconstruction times are tabulated for clinical relevance. The resulting SOS map is used to create a refraction corrected reflection image at ∼3.6 MHz center frequency. The transmission data are highly redundant, collected over 360 degrees and at 2 mm levels by true matrix receiver arrays yielding 3D data. The high resolution SOS and attenuation maps and reflection images are used in a segmentation algorithm that optimally utilizes this information to segment out glandular, ductal, connective tissue, fat and skin. These volumes are used to estimate breast density, an important correlate to cancer. RESULTS Multiple SOS images of breast, knee and segmentations of breast glandular and ductal tissue are shown. Spearman rho is calculated between our volumetric breast density estimates and Volpara™ from mammograms, as 0.9332. Multiple timing results are shown and indicate the variability of the reconstruction times with breast size and type but are ∼30 minutes for average size breast. The timing results with the 3D algorithm indicate ∼60 minute reconstruction times for pediatrics with two Nvidia GPUs. Characteristic variations of the glandular and ductal volumes over time are shown. The SOS from QT images are compared with literature values. The results of a multi-reader multi-case (MRMC) study are shown that compares the 3D UT with full field digital mammography and resulted in an average increase in ROC AUC of 10%. Orthopedic (knee) 3D UT images compared with MRI indicate regions of zero signal in the MRI are clearly displayed in the QT image. Explicit representation of the acoustic field is shown, indicating its 3D nature. An image of in vivo breast with the chest muscle is shown and speed of sound agreement with literature values are tabulated. Reference is made to a recently published paper validating pediatric imaging. CONCLUSIONS The high Spearman rho indicates a monotonic (not necessarily linear) relation between our method and industry gold standard Volpara™ density. The acoustic field verifies the need for 3D modeling. The MRMC study, the orthopedic images, breast density study, and references, all indicate the clinical utility of the SOS and reflection images. The QT image of the knee shows its ability to monitor tissue the MRI cannot. The included references and images herein indicate the proof of concept for 3D UT as a viable and valuable clinical adjunct in pediatric and orthopedic situations in addition to the breast imaging.
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Affiliation(s)
- James Wiskin
- QT Imaging, Inc, 3 Hamilton Landing, Suite 160, CA 94949, USA.
| | - Bilal Malik
- QT Imaging, Inc, 3 Hamilton Landing, Suite 160, CA 94949, USA
| | - John Klock
- QT Imaging, Inc, 3 Hamilton Landing, Suite 160, CA 94949, USA
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Klock J. Clinical Importance of 3D Volography in Breast Imaging. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1403:239-249. [PMID: 37495921 DOI: 10.1007/978-3-031-21987-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
The clinical applications of the volography algorithm and concomitant refraction-corrected reflection algorithm as described in Chap. 10 are discussed here. Comparisons with an H&E stained image, discussion of glandular tissue visibility, related biomarkers, segmentation accuracy and capabilities, microcalcification and cyst detection and analysis, and various VGA and clinical studies show the unique capabilities of the method. The accuracy of the fibroglandular segmentation and its relevance to breast density in imaging is mentioned. The compatibility with artificial intelligence (AI) is shown and clinical results discussed, concluding that low-frequency 3D ultrasound volography is a powerful 3D ultrasound imaging technique for microanatomic and quantitative features of the breast with good potential for AI utilization to provide an imaging technique that will quantitatively improve clinical performance.
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Wiacek A, Oluyemi E, Myers K, Ambinder E, Bell MAL. Coherence Metrics for Reader-Independent Differentiation of Cystic From Solid Breast Masses in Ultrasound Images. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:256-268. [PMID: 36333154 PMCID: PMC9712258 DOI: 10.1016/j.ultrasmedbio.2022.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 06/16/2023]
Abstract
Traditional breast ultrasound imaging is a low-cost, real-time and portable method to assist with breast cancer screening and diagnosis, with particular benefits for patients with dense breast tissue. We previously demonstrated that incorporating coherence-based beamforming additionally improves the distinction of fluid-filled from solid breast masses, based on qualitative image interpretation by board-certified radiologists. However, variable sensitivity (range: 0.71-1.00 when detecting fluid-filled masses) was achieved by the individual radiologist readers. Therefore, we propose two objective coherence metrics, lag-one coherence (LOC) and coherence length (CL), to quantitatively determine the content of breast masses without requiring reader assessment. Data acquired from 31 breast masses were analyzed. Ideal separation (i.e., 1.00 sensitivity and specificity) was achieved between fluid-filled and solid breast masses based on the mean or median LOC value within each mass. When separated based on mean and median CL values, the sensitivity/specificity decreased to 1.00/0.95 and 0.92/0.89, respectively. The greatest sensitivity and specificity were achieved in dense, rather than non-dense, breast tissue. These results support the introduction of an objective, reader-independent method for automated diagnoses of cystic breast masses.
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Affiliation(s)
- Alycen Wiacek
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Eniola Oluyemi
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Kelly Myers
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Emily Ambinder
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Muyinatu A Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
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Song J, Zhang Q, Zhou L, Quan Z, Wang S, Liu Z, Fang X, Wu Y, Yang Q, Yin H, Ding M, Yuchi M. Design and Implementation of a Modular and Scalable Research Platform for Ultrasound Computed Tomography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:62-72. [PMID: 34410922 DOI: 10.1109/tuffc.2021.3105691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Increasing attention has been attracted to the research of ultrasound computed tomography (USCT). This article reports the design considerations and implementation details of a novel USCT research system named UltraLucid, which aims to provide a user-friendly platform for researchers to develop new algorithms and conduct clinical trials. The modular design strategy is adopted to make the system highly scalable. A prototype has been assembled in our laboratory, which is equipped with a 2048-element ring transducer, 1024 transmit (TX) channels, 1024 receive (RX) channels, two servers, and a control unit. The prototype can acquire raw data from 1024 channels simultaneously using a modular data acquisition and a transfer system, consisting of 16 excitation and data acquisition (EDAQ) boards. Each EDAQ board has 64 independent TX and RX channels and 4-Gb Ethernet interfaces for raw data transmission. The raw data can be transferred to two servers at a theoretical rate of 64 Gb/s. Both servers are equipped with a 10.9-TB solid-state drive (SSD) array that can store raw data for offline processing. Alternatively, after processing by onboard field-programmable gate arrays (FPGAs), the raw data can be processed online using multicore central processing units (CPUs) and graphics processing units (GPUs) in each server. Through control software running on the host computer, the researchers can configure parameters for transmission, reception, and data acquisition. Novel TX-RX scheme and coded imaging can be implemented. The modular hardware structure and the software-based processing strategy make the system highly scalable and flexible. The system performance is evaluated with phantoms and in vivo experiments.
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Malik B, Iuanow E, Klock J. An Exploratory Multi-reader, Multi-case Study Comparing Transmission Ultrasound to Mammography on Recall Rates and Detection Rates for Breast Cancer Lesions. Acad Radiol 2022; 29 Suppl 1:S10-S18. [PMID: 33281042 DOI: 10.1016/j.acra.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Three-dimensional Quantitative Transmission (QT) ultrasound imaging is an emerging modality for improving the detection and diagnosis of breast cancer. QT ultrasound has high resolution and high contrast to noise ratio, making it effective in evaluating breast tissue. This study compares radiologists' performance of noncancer recall rates and lesion detection rates using QT Ultrasound versus full-field digital mammography (FFDM) in a cross section of female subjects. MATERIALS AND METHODS In this multi-reader multi-case (MRMC) study, we examined retrospective data from two clinical trials conducted at five sites. All subjects received FFDM and QT scans within 90 days. Data were analyzed in a reader study with full factorial design involving 22 radiologists and 108 breast cases (42 normal, 39 pathology-confirmed benign, and 27 pathology-confirmed cancer cases). The main results used a random-reader random-case analysis adjusted for location bias performed after a primary predefined random-reader fixed-case analysis. RESULTS The readers' mean rate of detecting lesions of any type was 4% higher (p-value > 0.05) with QT imaging. The mean non-cancer recall rate improved significantly, showing a decrease of 16% with QT (p-value = 0.03), at the expense of a 2% decrease in the mean cancer recall rate (p-value >0.05) in comparison to FFDM. Combining performance on cancer and noncancer recall rates, the mean area under the receiver operator curve of confidence scores improved significantly by 10% with QT (p-value = 0.01). CONCLUSION This MRMC study indicates that QT improves non-cancer recall rates without substantially affecting cancer recall rates. The main limitation is the small number of cases from retrospective data. A larger prospective MRMC study is warranted for further assessment.
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Duric N, Sak M, Littrup PJ. The Potential Role of the Fat-Glandular Interface (FGI) in Breast Carcinogenesis: Results from an Ultrasound Tomography (UST) Study. J Clin Med 2021; 10:5615. [PMID: 34884317 PMCID: PMC8658427 DOI: 10.3390/jcm10235615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
This study explored the relationship between the extent of the fat-glandular interface (FGI) and the presence of malignant vs. benign lesions. Two hundred and eight patients were scanned with ultrasound tomography (UST) as part of a Health Insurance Portability and Accountability Act (HIPAA)-compliant study. Segmentation of the sound speed images, employing the k-means clustering method, was used to help define the extent of the FGI for each patient. The metric, α, was defined as the surface area to volume ratio of the segmented fibroglandular volume and its mean value across patients was determined for cancers, fibroadenomas and cysts. ANOVA tests were used to assess significance. The means and standard deviations of α for cancers, fibroadenomas and cysts were found to be 4.0 ± 2.0 cm-1, 3.1 ± 1.7 cm-1 and 2.3 ± 0.9 cm-1, respectively. The differences were statistically significant (p < 0.001). The separation between the groups increased when α was measured on only the image slice where the finding was most prominent, with values for cancers, fibroadenomas and cysts of 5.4 ± 3.6 cm-1, 3.6 ± 2.3 cm-1 and 2.4 ± 1.5 cm-1, respectively. Of the three types of masses studied, cancer was associated with the most extensive FGIs, suggesting a potential role for the FGI in carcinogenesis, a subject for future studies.
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Affiliation(s)
- Nebojsa Duric
- Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA
- Delphinus Medical Technologies Inc., Novi, MI 48374, USA;
| | - Mark Sak
- School of Medicine, Wayne State University, Detroit, MI 48202, USA;
| | - Peter J. Littrup
- Delphinus Medical Technologies Inc., Novi, MI 48374, USA;
- School of Medicine, Wayne State University, Detroit, MI 48202, USA;
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Littrup PJ, Duric N, Sak M, Li C, Roy O, Brem RF, Larsen LH, Yamashita M. Multicenter Study of Whole Breast Stiffness Imaging by Ultrasound Tomography (SoftVue) for Characterization of Breast Tissues and Masses. J Clin Med 2021; 10:5528. [PMID: 34884229 PMCID: PMC8658621 DOI: 10.3390/jcm10235528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 12/16/2022] Open
Abstract
We evaluated whole breast stiffness imaging by SoftVue ultrasound tomography (UST), extracted from the bulk modulus, to volumetrically map differences in breast tissues and masses. A total 206 women with either palpable or mammographically/sonographically visible masses underwent UST scanning prior to biopsy as part of a prospective, HIPAA-compliant multicenter cohort study. The volumetric data sets comprised 298 masses (78 cancers, 105 fibroadenomas, 91 cysts and 24 other benign) in 239 breasts. All breast tissues were segmented into six categories, using sound speed to separate fat from fibroglandular tissues, and then subgrouped by stiffness into soft, intermediate and hard components. Ninety percent of women had mammographically dense breasts but only 11.2% of their total breast volume showed hard components while 69% of fibroglandular tissues were softer. All smaller masses (<1.5 cm) showed a greater percentage of hard components than their corresponding larger masses (p < 0.001). Cancers had significantly greater mean stiffness indices and lower mean homogeneity of stiffness than benign masses (p < 0.05). SoftVue stiffness imaging demonstrated small stiff masses, mainly due to cancers, amongst predominantly soft breast tissues. Quantitative stiffness mapping of the whole breast and underlying masses may have implications for screening of women with dense breasts, cancer risk evaluations, chemoprevention and treatment monitoring.
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Affiliation(s)
- Peter J. Littrup
- Department of Radiology, Karmanos Cancer Institute, Detroit, MI 48201, USA
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
- Delphinus Medical Technologies Inc., Novi, MI 48374, USA; (N.D.); (M.S.); (C.L.); (O.R.)
| | - Nebojsa Duric
- Delphinus Medical Technologies Inc., Novi, MI 48374, USA; (N.D.); (M.S.); (C.L.); (O.R.)
- Department of Radiology, University of Rochester, Rochester, NY 14642, USA
| | - Mark Sak
- Delphinus Medical Technologies Inc., Novi, MI 48374, USA; (N.D.); (M.S.); (C.L.); (O.R.)
| | - Cuiping Li
- Delphinus Medical Technologies Inc., Novi, MI 48374, USA; (N.D.); (M.S.); (C.L.); (O.R.)
| | - Olivier Roy
- Delphinus Medical Technologies Inc., Novi, MI 48374, USA; (N.D.); (M.S.); (C.L.); (O.R.)
| | - Rachel F. Brem
- Department of Radiology, The George Washington Cancer Center, George Washington University, Washington, DC 20037, USA;
| | - Linda H. Larsen
- Department of Radiology, Norris Cancer Center and Hospital, University of Southern California, Los Angeles, CA 90033, USA; (L.H.L.); (M.Y.)
| | - Mary Yamashita
- Department of Radiology, Norris Cancer Center and Hospital, University of Southern California, Los Angeles, CA 90033, USA; (L.H.L.); (M.Y.)
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Littrup PJ, Duric N, Sak M, Li C, Roy O, Brem RF, Yamashita M. The Fat-glandular Interface and Breast Tumor Locations: Appearances on Ultrasound Tomography Are Supported by Quantitative Peritumoral Analyses. JOURNAL OF BREAST IMAGING 2021; 3:455-464. [PMID: 38424790 DOI: 10.1093/jbi/wbab032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To analyze the preferred tissue locations of common breast masses in relation to anatomic quadrants and the fat-glandular interface (FGI) using ultrasound tomography (UST). METHODS Ultrasound tomography scanning was performed in 206 consecutive women with 298 mammographically and/or sonographically visible, benign and malignant breast masses following written informed consent to participate in an 8-site multicenter, Institutional Review Board-approved cohort study. Mass locations were categorized by their anatomic breast quadrant and the FGI, which was defined by UST as the high-contrast circumferential junction of fat and fibroglandular tissue on coronal sound speed imaging. Quantitative UST mass comparisons were done for each tumor and peritumoral region using mean sound speed and percentage of fibroglandular tissue. Chi-squared and analysis of variance tests were used to assess differences. RESULTS Cancers were noted at the FGI in 95% (74/78) compared to 51% (98/194) of fibroadenomas and cysts combined (P < 0.001). No intra-quadrant differences between cancer and benign masses were noted for tumor location by anatomic quadrants (P = 0.66). Quantitative peritumoral sound speed properties showed that cancers were surrounded by lower mean sound speeds (1477 m/s) and percent fibroglandular tissue (47%), compared to fibroadenomas (1496 m/s; 65.3%) and cysts (1518 m/s; 84%) (P < 0.001; P < 0.001, respectively). CONCLUSION Breast cancers form adjacent to fat and UST localized the vast majority to the FGI, while cysts were most often completely surrounded by dense tissue. These observations were supported by quantitative peritumoral analyses of sound speed values for fat and fibroglandular tissue.
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Affiliation(s)
- Peter J Littrup
- Departments of Radiology and Oncology, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, Wayne State University, Detroit, Novi, MI, USA
- Delphinus Medical Technologies, Inc., Novi, MI, USA
| | - Nebojsa Duric
- Departments of Radiology and Oncology, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, Wayne State University, Detroit, Novi, MI, USA
- Delphinus Medical Technologies, Inc., Novi, MI, USA
| | - Mark Sak
- Delphinus Medical Technologies, Inc., Novi, MI, USA
| | - Cuiping Li
- Delphinus Medical Technologies, Inc., Novi, MI, USA
| | - Olivier Roy
- Delphinus Medical Technologies, Inc., Novi, MI, USA
| | - Rachel F Brem
- The George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Mary Yamashita
- University of Southern California; Norris Cancer Center and Hospital, Los Angeles, CA, USA
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Rau R, Schweizer D, Vishnevskiy V, Goksel O. Speed-of-sound imaging using diverging waves. Int J Comput Assist Radiol Surg 2021; 16:1201-1211. [PMID: 34160749 PMCID: PMC8260432 DOI: 10.1007/s11548-021-02426-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/28/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Due to its safe, low-cost, portable, and real-time nature, ultrasound is a prominent imaging method in computer-assisted interventions. However, typical B-mode ultrasound images have limited contrast and tissue differentiation capability for several clinical applications. METHODS Recent introduction of imaging speed-of-sound (SoS) in soft tissues using conventional ultrasound systems and transducers has great potential in clinical translation providing additional imaging contrast, e.g., in intervention planning, navigation, and guidance applications. However, current pulse-echo SoS imaging methods relying on plane wave (PW) sequences are highly prone to aberration effects, therefore suboptimal in image quality. In this paper we propose using diverging waves (DW) for SoS imaging and study this comparatively to PW. RESULTS We demonstrate wavefront aberration and its effects on the key step of displacement tracking in the SoS reconstruction pipeline, comparatively between PW and DW on a synthetic example. We then present the parameterization sensitivity of both approaches on a set of simulated phantoms. Analyzing SoS imaging performance comparatively indicates that using DW instead of PW, the reconstruction accuracy improves by over 20% in root-mean-square-error (RMSE) and by 42% in contrast-to-noise ratio (CNR). We then demonstrate SoS reconstructions with actual US acquisitions of a breast phantom. With our proposed DW, CNR for a high contrast tumor-representative inclusion is improved by 42%, while for a low contrast cyst-representative inclusion a 2.8-fold improvement is achieved. CONCLUSION SoS imaging, so far only studied using a plane wave transmission scheme, can be made more reliable and accurate using DW. The high imaging contrast of DW-based SoS imaging will thus facilitate the clinical translation of the method and utilization in computer-assisted interventions such as ultrasound-guided biopsies, where B-Mode contrast is often to low to detect potential lesions.
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Affiliation(s)
- Richard Rau
- Computer-assisted Applications in Medicine group, ETH Zurich, Zurich, Switzerland
| | - Dieter Schweizer
- Computer-assisted Applications in Medicine group, ETH Zurich, Zurich, Switzerland
| | - Valery Vishnevskiy
- Computer-assisted Applications in Medicine group, ETH Zurich, Zurich, Switzerland
| | - Orcun Goksel
- Computer-assisted Applications in Medicine group, ETH Zurich, Zurich, Switzerland
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Bernhardt M, Vishnevskiy V, Rau R, Goksel O. Training Variational Networks With Multidomain Simulations: Speed-of-Sound Image Reconstruction. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2584-2594. [PMID: 32746211 DOI: 10.1109/tuffc.2020.3010186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Speed-of-sound (SoS) has been shown as a potential biomarker for breast cancer imaging, successfully differentiating malignant tumors from benign ones. SoS images can be reconstructed from time-of-flight measurements from ultrasound images acquired using conventional handheld ultrasound transducers. Variational networks (VNs) have recently been shown to be a potential learning-based approach for optimizing inverse problems in image reconstruction. Despite earlier promising results, these methods, however, do not generalize well from simulated to acquired data, due to the domain shift. In this work, we present for the first time a VN solution for a pulse-echo SoS image reconstruction problem using diverging waves with conventional transducers and single-sided tissue access. This is made possible by incorporating simulations with varying complexity into training. We use loop unrolling of gradient descent with momentum, with an exponentially weighted loss of outputs at each unrolled iteration in order to regularize the training. We learn norms as activation functions regularized to have smooth forms for robustness to input distribution variations. We evaluate reconstruction quality on the ray-based and full-wave simulations as well as on the tissue-mimicking phantom data, in comparison with a classical iterative [limited-memory Broyden-Fletcher-Goldfarb-Shanno (L-BFGS)] optimization of this image reconstruction problem. We show that the proposed regularization techniques combined with multisource domain training yield substantial improvements in the domain adaptation capabilities of VN, reducing the median root mean squared error (RMSE) by 54% on a wave-based simulation data set compared to the baseline VN. We also show that on data acquired from a tissue-mimicking breast phantom, the proposed VN provides improved reconstruction in 12 ms.
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Breast Cancer Assessment With Pulse-Echo Speed of Sound Ultrasound From Intrinsic Tissue Reflections: Proof-of-Concept. Invest Radiol 2020; 54:419-427. [PMID: 30913054 DOI: 10.1097/rli.0000000000000553] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to differentiate malignant and benign solid breast lesions with a novel ultrasound (US) technique, which measures speed of sound (SoS) using standard US transducers and intrinsic tissue reflections and scattering (speckles) as internal reference. MATERIALS AND METHODS This prospective, institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective comparison study was performed with prior written informed consent from 20 women. Ten women with histological proven breast cancer and 10 with fibroadenoma were measured. A conventional US system with a linear probe was used for SoS-US (SonixTouch; Ultrasonix, Richmond, British Columbia, Canada). Tissue speckle reflections served as a timing reference for the US signals transmitted through the breasts. Relative phase inconsistencies were detected using plane wave measurements from different angular directions, and SoS images with 0.5-mm resolution were generated using a spatial domain reconstruction algorithm. The SoS of tumors were compared with the breast density of a larger cohort of 106 healthy women. RESULTS Breast lesions show focal increments ΔSoS (meters per second) with respect to the tissue background. Peak ΔSoS values were evaluated. Breast carcinoma showed significantly higher ΔSoS than fibroadenomas ([INCREMENT]SoS > 41.64 m/s: sensitivity, 90%; specificity, 80%; area under curve, 0.910) and healthy breast tissue of different densities (area under curve, 0.938; sensitivity, 90%; specificity, 96.5%). The lesion localization in SoS-US images was consistent with B-mode imaging and repeated SoS-US measurements were reproducible. CONCLUSIONS Using SoS-US, based on conventional US and tissue speckles as timing reference, breast carcinoma showed significantly higher SoS values than fibroadenoma and healthy breast tissue of different densities. The SoS presents a promising technique for differentiating solid breast lesions.
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Malik BH, Klock JC. Breast Cyst Fluid Analysis Correlations with Speed of Sound Using Transmission Ultrasound. Acad Radiol 2019; 26:76-85. [PMID: 29887398 PMCID: PMC6286231 DOI: 10.1016/j.acra.2018.03.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this work is to determine if the speed of sound value of a breast cyst can aid in the clinical management of breast masses. Breast macrocysts are defined as fluid-filled tissue masses >1 cm in diameter and are thought to be aberrations of normal development and involution, often associated with apocrine metaplasia. The benign natural history of breast cysts is well known, and it is important to obtain high specificity in breast imaging to avoid unnecessary biopsies in women who have benign diseases, particularly those with dense breast tissue. Transmission ultrasound is a tomographic imaging modality that generates high-resolution, 3D speed of sound maps that could be used to identify breast tissue types and act as a biomarker to differentiate lesions. We performed this study to investigate the microanatomy of macrocysts observed using transmission ultrasound, as well as assess the relationship of speed of sound to the physical and biochemical parameters of cyst fluids. MATERIALS AND METHODS Cyst fluid samples were obtained from 37 patients as part of a case-collection study for ultrasound imaging of the breast. The speed of sound of each sample was measured using a quantitative transmission ultrasound scanner in vivo. Electrolytes, protein, cholesterol, viscosity, and specific gravity were also measured (in the aspirated cyst fluid) to assess their relationship to the speed of sound values obtained during breast imaging. RESULTS We found positive correlations between viscosity and cholesterol (r = 0.71) and viscosity and total protein × cholesterol (r = 0.78). Additionally, we performed direct cell counts on cyst fluids and confirmed a positive correlation of number of cells with speed of sound (r = 0.74). The speed of sound of breast macrocysts, as observed using transmission ultrasound, correlated with the cytological features of intracystic cell clumps. CONCLUSION On the basis of our work with speed as a classifier, we propose a spectrum of breast macrocysts from fluid-filled to highly cellular. Our results suggest high-speed cysts are mature macrocysts with high cell counts and many cellular clumps that correlate with cyst microanatomy as seen by transmission ultrasound. Further studies are needed to confirm our findings and to assess the clinical value of speed of sound measurements in breast imaging using transmission ultrasound.
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Affiliation(s)
- Bilal H Malik
- QT Ultrasound Labs, 3 Hamilton Landing Suite 160, Novato, California 94949.
| | - John C Klock
- QT Ultrasound Labs, 3 Hamilton Landing Suite 160, Novato, California 94949
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Malik B, Terry R, Wiskin J, Lenox M. Quantitative transmission ultrasound tomography: Imaging and performance characteristics. Med Phys 2018; 45:3063-3075. [PMID: 29745992 PMCID: PMC6041196 DOI: 10.1002/mp.12957] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Quantitative Transmission (QT) ultrasound has shown promise as a breast imaging modality. This study characterizes the performance of the latest generation of QT ultrasound scanners: QT Scanner 2000. METHODS The scanner consists of a 2048-element ultrasound receiver array for transmission imaging and three transceivers for reflection imaging. Custom fabricated phantoms were used to quantify the imaging performance parameters. The specific performance parameters that have been characterized are spatial resolution (as point spread function), linear measurement accuracy, contrast to noise ratio, and image uniformity, in both transmission and reflection imaging modalities. RESULTS The intrinsic in-plane resolution was measured to be better than 1.5 mm and 1.0 mm for transmission and reflection modalities respectively. The linear measurement accuracy was measured to be, on average, approximately 1% for both the modalities. Speed of sound image uniformity and measurement accuracy were calculated to be 99.5% and <0.2% respectively. Contrast to noise ratio (CNR) measurements vary as a function of object size. CONCLUSIONS The results show an improvement in the imaging performance of the system in comparison to earlier ultrasound tomography systems, which are applicable to clinical applications of the system, such as breast imaging.
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Affiliation(s)
- Bilal Malik
- QT Ultrasound3 Hamilton Landing, Suite 160NovatoCA94949USA
| | - Robin Terry
- QT Ultrasound3 Hamilton Landing, Suite 160NovatoCA94949USA
| | - James Wiskin
- QT Ultrasound3 Hamilton Landing, Suite 160NovatoCA94949USA
| | - Mark Lenox
- QT Ultrasound3 Hamilton Landing, Suite 160NovatoCA94949USA
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Obuchowski NA, Bullen JA. Receiver operating characteristic (ROC) curves: review of methods with applications in diagnostic medicine. ACTA ACUST UNITED AC 2018; 63:07TR01. [DOI: 10.1088/1361-6560/aab4b1] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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