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

Reconstructing the Spatial Distribution of the Relative Shear Modulus in Quasi-static Ultrasound Elastography: Plane Stress Analysis

Quasi-static ultrasound elastography (QSUE) is an imaging technique that mainly provides axial strain maps of tissues when the latter are subjected to compression. In this article, a method for reconstructing the relative shear modulus distribution within a linear elastic and isotropic medium, in QSUE, is introduced. More specifically, the plane stress inverse problem is considered. The proposed method is based on the variational formulation of the equilibrium equations and on the choice of adapted discretization spaces, and only requires displacement fields in the analyzed media to be determined. Results from plane stress and 3-D numerical simulations, as well as from phantom experiments, showed that the method is able to reconstruct the different regions within a medium, with shear modulus contrasts that unambiguously reveal whether inclusions are stiffer or softer than the surrounding material. More specifically, for the plane stress simulations, inclusion-to-background modulus ratios were found to be very accurately estimated, with an error lower than 3%. For the 3-D simulations, for which the plane stress conditions are no longer satisfied, these ratios were, as expected, less accurate, with an error that remained lower than 10% for two of the three cases analyzed but was around 34% for the last case. Concerning the phantom experiments, a comparison with a shear wave elastography technique from a clinical ultrasound scanner was also made. Overall, the inclusion-to-background shear modulus ratios obtained with our approach were found to be closer to those given by the phantom manufacturer than the ratios provided by the clinical system.

Integrated optical coherence tomography and multielement ultrasound transducer probe for shear wave elasticity imaging of moving tissues

Accurate measurements of microelastic properties of soft tissues in-vivo using optical coherence elastography can be affected by motion artifacts caused by cardiac and respiratory cycles. This problem can be overcome using a multielement ultrasound transducer probe where each ultrasound transducer is capable of generating acoustic radiation force (ARF) and, therefore, creating shear waves in tissue. These shear waves, produced during the phase of cardiac and respiratory cycles when tissues are effectively stationary, are detected at the same observation point using phase-sensitive optical coherence tomography (psOCT). Given the known distance between the ultrasound transducers, the speed of shear wave propagation can be calculated by measuring the difference between arrival times of shear waves. The combined multitransducer ARF/psOCT probe has been designed and tested in phantoms and ex-vivo studies using fresh rabbit heart. The measured values of shear moduli are in good agreement with those reported in literature. Our results suggest that the developed multitransducer ARF/psOCT probe can be useful for many in-vivo applications, including quantifying the microelasticity of cardiac muscle.

High shear stress induces atherosclerotic vulnerable plaque formation through angiogenesis

Rupture of atherosclerotic plaques causing thrombosis is the main cause of acute coronary syndrome and ischemic strokes. Inhibition of thrombosis is one of the important tasks developing biomedical materials such as intravascular stents and vascular grafts. Shear stress (SS) influences the formation and development of atherosclerosis. The current review focuses on the vulnerable plaques observed in the high shear stress (HSS) regions, which localizes at the proximal region of the plaque intruding into the lumen. The vascular outward remodelling occurs in the HSS region for vascular compensation and that angiogenesis is a critical factor for HSS which induces atherosclerotic vulnerable plaque formation. These results greatly challenge the established belief that low shear stress is important for expansive remodelling, which provides a new perspective for preventing the transition of stable plaques to high-risk atherosclerotic lesions.

Application of Eshelby's Solution to Elastography for Diagnosis of Breast Cancer

Eshelby's solution is the analytical method that can derive the elastic field within and around an ellipsoidal inclusion embedded in a matrix. Since breast tumor can be regarded as an elastic inclusion with different elastic properties from those of surrounding matrix when the deformation is small, we applied Eshelby's solution to predict the stress and strain fields in the breast containing a suspicious lesion. The results were used to investigate the effectiveness of strain ratio (SR) from elastography in representing modulus ratio (MR) that may be the meaningful indicator of the malignancy of the lesion. This study showed that SR significantly underestimates MR and is varied with the shape and the modulus of the lesion. Based on the results from Eshelby's solution and finite element analysis (FEA), we proposed a surface regression model as a polynomial function that can predict the MR of the lesion to the matrix. The model has been applied to gelatin-based phantoms and clinical ultrasound images of human breasts containing different types of lesions. The results suggest the potential of the proposed method to improve the diagnostic performance of breast cancer using elastography.

Carotid plaque elasticity estimation using ultrasound elastography, MRI, and inverse FEA - A numerical feasibility study

The material properties of atherosclerotic plaques govern the biomechanical environment, which is associated with rupture-risk. We investigated the feasibility of noninvasively estimating carotid plaque component material properties through simulating ultrasound (US) elastography and in vivo magnetic resonance imaging (MRI), and solving the inverse problem with finite element analysis. 2D plaque models were derived from endarterectomy specimens of nine patients. Nonlinear neo-Hookean models (tissue elasticity C1) were assigned to fibrous intima, wall (i.e., media/adventitia), and lipid-rich necrotic core. Finite element analysis was used to simulate clinical cross-sectional US strain imaging. Computer-simulated, single-slice in vivo MR images were segmented by two MR readers. We investigated multiple scenarios for plaque model elasticity, and consistently found clear separations between estimated tissue elasticity values. The intima C1 (160 kPa scenario) was estimated as 125.8 ± 19.4 kPa (reader 1) and 128.9 ± 24.8 kPa (reader 2). The lipid-rich necrotic core C1 (5 kPa) was estimated as 5.6 ± 2.0 kPa (reader 1) and 8.5 ± 4.5 kPa (reader 2). A scenario with a stiffer wall yielded similar results, while realistic US strain noise and rotating the models had little influence, thus demonstrating robustness of the procedure. The promising findings of this computer-simulation study stimulate applying the proposed methodology in a clinical setting.

Visualizing the stress distribution within vascular tissues using intravascular ultrasound elastography: a preliminary investigation

A methodology for computing the stress distribution of vascular tissue using finite element-based, intravascular ultrasound (IVUS) reconstruction elastography is described. This information could help cardiologists detect life-threatening atherosclerotic plaques and predict their propensity to rupture. The calculation of vessel stresses requires the measurement of strain from the ultrasound images, a calibrating pressure measurement and additional model assumptions. In this work, we conducted simulation studies to investigate the effect of varying the model assumptions, specifically Poisson's ratio and the outer boundary conditions, on the resulting stress fields. In both simulation and phantom studies, we created vessel geometries with two fibrous cap thicknesses to determine if we could detect a difference in peak stress (spatially) between the two. The results revealed that (i) Poisson's ratios had negligible impact on the accuracy of stress elastograms, (ii) the outer boundary condition assumption had the greatest effect on the resulting modulus and stress distributions and (iii) in simulation and in phantom experiments, our stress imaging technique was able to detect an increased peak stress for the vessel geometry with the smaller cap thickness. This work is a first step toward understanding and creating a robust stress measurement technique for evaluating atherosclerotic plaques using IVUS elastography.

Vascular elastography: a validation study

Vascular elastography techniques are promising tools for mechanical characterization of diseased arteries. These techniques are usually validated with simulations or phantoms or by comparing results with histology or other imaging modalities. In the study described here, vascular elastography was applied to porcine aortas in vitro during inflation testing (n = 10) and results were compared with those of standard bi-axial tensile testing, a technique that directly measures the force applied to the tissue. A neo-Hookean model was fit to the stress-strain data, valid for large deformations. Results indicated good correspondence between the two techniques, with GUS = 110 ± 11 kPa and GTT = 108 ± 10 kPa for ultrasound and tensile testing, respectively. Bland-Altman analysis revealed little bias (GUS-GTT = 2 ± 20 kPa). The next step will be the application of a non-linear material model that is also adaptable for in vivo measurements.

EFFECT OF STRESS INTENSITY FACTOR IN EVALUATION OF INSTABILITY OF ATHEROSCLEROTIC PLAQUE

Understanding the relationship between coronary arterial blood pressure, plaque morphology and composition, and sites of fibrous cap (FC) bursting, has been the focus of many recent studies. Instability of atherosclerotic plaques, defined as the propensity for FCs to burst, has been thought to occur at places where FCs are thin and necrotic core (NC) areas are large and highly compliant. However, here we show quantitatively, using a fiber-reinforced, anisotropic and hyperelastic FE model, that FC thickness and NC size and compliance alone are limited in predicting vulnerable and high-risk plaques. We suggest that plaque instabilities primarily occur at sites of high and concentrated mechanical stresses irrespective of fibrous cap thickness or NC area and compliance. Also, limitations of imaging techniques, such as intravascular ultrasound and optical coherence tomography, for providing input into (FE) models of atherosclerosis are discussed. The proposed model can be used to predict vulnerable plaque sites and rupture risks in patients. The current study also provides a framework for future research in which three-dimensional platform and viscoelastic properties of plaque composition can be considered in time-dependent and fatigue studies.

Including spatial information in nonlinear inversion MR elastography using soft prior regularization

Tissue displacements required for mechanical property reconstruction in magnetic resonance elastography (MRE) are acquired in a magnetic resonance imaging (MRI) scanner, therefore, anatomical information is available from other imaging sequences. Despite its availability, few attempts to incorporate prior spatial information in the MRE reconstruction process have been reported. This paper implements and evaluates soft prior regularization (SPR), through which homogeneity in predefined spatial regions is enforced by a penalty term in a nonlinear inversion strategy. Phantom experiments and simulations show that when predefined regions are spatially accurate, recovered property values are stable for SPR weighting factors spanning several orders of magnitude, whereas inaccurate segmentation results in bias in the reconstructed properties that can be mitigated through proper choice of regularization weighting. The method was evaluated in vivo by estimating viscoelastic mechanical properties of frontal lobe gray and white matter for five repeated scans of a healthy volunteer. Segmentations of each tissue type were generated using automated software, and statistically significant differences between frontal lobe gray and white matter were found for both the storage modulus and loss modulus . Provided homogeneous property assumptions are reasonable, SPR produces accurate quantitative property estimates for tissue structures which are finer than the resolution currently achievable with fully distributed MRE.

Biomechanics of atherosclerotic coronary plaque: site, stability and in vivo elasticity modeling

Coronary atheroma develop in local sites that are widely variable among patients and are considerably variable in their vulnerability for rupture. This article summarizes studies conducted by our collaborative laboratories on predictive biomechanical modeling of coronary plaques. It aims to give insights into the role of biomechanics in the development and localization of atherosclerosis, the morphologic features that determine vulnerable plaque stability, and emerging in vivo imaging techniques that may detect and characterize vulnerable plaque. Composite biomechanical and hemodynamic factors that influence the actual site of development of plaques have been studied. Plaque vulnerability, in vivo, is more challenging to assess. Important steps have been made in defining the biomechanical factors that are predictive of plaque rupture and the likelihood of this occurring if characteristic features are known. A critical key in defining plaque vulnerability is the accurate quantification of both the morphology and the mechanical properties of the diseased arteries. Recently, an early IVUS based palpography technique developed to assess local strain, elasticity and mechanical instabilities has been successfully revisited and improved to account for complex plaque geometries. This is based on an initial best estimation of the plaque components' contours, allowing subsequent iteration for elastic modulus assessment as a basis for plaque stability determination. The improved method has also been preliminarily evaluated in patients with successful histologic correlation. Further clinical evaluation and refinement are on the horizon.

Non-rigid image registration based strain estimator for intravascular ultrasound elastography

Intravascular ultrasound elastography (IVUSe) could improve the diagnosis of cardiovascular disease by revealing vulnerable plaques through their mechanical tissue properties. To improve the performance of IVUSe, we developed and implemented a non-rigid image-registration method to visualize the radial and circumferential component of strain within vascular tissues. We evaluated the algorithm's performance with four initialization schemes using simulated and experimentally acquired ultrasound images. Applying the registration method to radio-frequency (RF) echo frames improved the accuracy of displacements compared to when B-mode images were employed. However, strain elastograms measured from RF echo frames produce erroneous results when both the zero-initialization method and the mesh-refinement scheme were employed. For most strain levels, the cross-correlation-initialization method produced the best performance. The simulation study predicted that elastograms obtained from vessels with average strains in the range of 3%-5% should have high elastographic signal-to-noise ratio (SNRe)-on the order of 4.5 and 7.5 for the radial and circumferential components of strain, respectively. The preliminary in vivo validation study (phantom and an atherosclerotic rabbit) demonstrated that the non-rigid registration method could produce useful radial and circumferential strain elastograms under realistic physiologic conditions. The results of this investigation were sufficiently encouraging to warrant a more comprehensive in vivo validation.

Realistic IVUS image generation in different intraluminal pressures

Intravascular ultrasound (IVUS) phantoms are important to calibrate and evaluate many IVUS imaging processing tasks. However, phantom generation is never the primary focus of related works; hence, it cannot be well covered, and is usually based on more than one platform, which may not be accessible to investigators. Therefore, we present a framework for creating representative IVUS phantoms, for different intraluminal pressures, based on the finite element method and Field II. First, a coronary cross-section model is selected. Second, the coronary regions are identified to apply the properties. Third, the corresponding mesh is generated. Fourth, the intraluminal force is applied and the deformation computed. Finally, the speckle noise is incorporated. The framework was tested taking into account IVUS contrast, noise and strains. The outcomes are in line with related studies and expected values. Moreover, the framework toolbox is freely accessible and fully implemented in a single platform.

Model-based elastography: a survey of approaches to the inverse elasticity problem

Elastography is emerging as an imaging modality that can distinguish normal versus diseased tissues via their biomechanical properties. This paper reviews current approaches to elastography in three areas--quasi-static, harmonic and transient--and describes inversion schemes for each elastographic imaging approach. Approaches include first-order approximation methods; direct and iterative inversion schemes for linear elastic; isotropic materials and advanced reconstruction methods for recovering parameters that characterize complex mechanical behavior. The paper's objective is to document efforts to develop elastography within the framework of solving an inverse problem, so that elastography may provide reliable estimates of shear modulus and other mechanical parameters. We discuss issues that must be addressed if model-based elastography is to become the prevailing approach to quasi-static, harmonic and transient elastography: (1) developing practical techniques to transform the ill-posed problem with a well-posed one; (2) devising better forward models to capture the complex mechanical behavior of soft tissues and (3) developing better test procedures to evaluate the performance of modulus elastograms.

Investigating the impact of spatial priors on the performance of model-based IVUS elastography

This paper describes methods that provide pre-requisite information for computing circumferential stress in modulus elastograms recovered from vascular tissue-information that could help cardiologists detect life-threatening plaques and predict their propensity to rupture. The modulus recovery process is an ill-posed problem; therefore, additional information is needed to provide useful elastograms. In this work, prior geometrical information was used to impose hard or soft constraints on the reconstruction process. We conducted simulation and phantom studies to evaluate and compare modulus elastograms computed with soft and hard constraints versus those computed without any prior information. The results revealed that (1) the contrast-to-noise ratio of modulus elastograms achieved using the soft prior and hard prior reconstruction methods exceeded those computed without any prior information; (2) the soft prior and hard prior reconstruction methods could tolerate up to 8% measurement noise, and (3) the performance of soft and hard prior modulus elastograms degraded when incomplete spatial priors were employed. This work demonstrates that including spatial priors in the reconstruction process should improve the performance of model-based elastography, and the soft prior approach should enhance the robustness of the reconstruction process to errors in the geometrical information.

On the potential of a new IVUS elasticity modulus imaging approach for detecting vulnerable atherosclerotic coronary plaques: in vitro vessel phantom study

Peak cap stress amplitude is recognized as a good indicator of vulnerable plaque (VP) rupture. However, such stress evaluation strongly relies on a precise, but still lacking, knowledge of the mechanical properties exhibited by the plaque components. As a first response to this limitation, our group recently developed, in a previous theoretical study, an original approach, called iMOD (imaging modulography), which reconstructs elasticity maps (or modulograms) of atheroma plaques from the estimation of strain fields. In the present in vitro experimental study, conducted on polyvinyl alcohol cryogel arterial phantoms, we investigate the benefit of coupling the iMOD procedure with the acquisition of intravascular ultrasound (IVUS) measurements for detection of VP. Our results show that the combined iMOD-IVUS strategy: (1) successfully detected and quantified soft inclusion contours with high positive predictive and sensitivity values of 89.7 ± 3.9% and 81.5 ± 8.8%, respectively, (2) estimated reasonably cap thicknesses larger than ∼300 µm, but underestimated thinner caps, and (3) quantified satisfactorily Young's modulus of hard medium (mean value of 109.7 ± 23.7 kPa instead of 145.4 ± 31.8 kPa), but overestimated the stiffness of soft inclusions (mean Young`s moduli of 31.4 ± 9.7 kPa instead of 17.6 ± 3.4 kPa). All together, these results demonstrate a promising benefit of the new iMOD-IVUS clinical imaging method for in vivo VP detection.

Vulnerable atherosclerotic plaque elasticity reconstruction based on a segmentation-driven optimization procedure using strain measurements: theoretical framework

It is now recognized that prediction of the vulnerable coronary plaque rupture requires not only an accurate quantification of fibrous cap thickness and necrotic core morphology but also a precise knowledge of the mechanical properties of plaque components. Indeed, such knowledge would allow a precise evaluation of the peak cap-stress amplitude, which is known to be a good biomechanical predictor of plaque rupture. Several studies have been performed to reconstruct a Young's modulus map from strain elastograms. It seems that the main issue for improving such methods does not rely on the optimization algorithm itself, but rather on preconditioning requiring the best estimation of the plaque components' contours. The present theoretical study was therefore designed to develop: 1) a preconditioning model to extract the plaque morphology in order to initiate the optimization process, and 2) an approach combining a dynamic segmentation method with an optimization procedure to highlight the modulogram of the atherosclerotic plaque. This methodology, based on the continuum mechanics theory prescribing the strain field, was successfully applied to seven intravascular ultrasound coronary lesion morphologies. The reconstructed cap thickness, necrotic core area, calcium area, and the Young's moduli of the calcium, necrotic core, and fibrosis were obtained with mean relative errors of 12%, 4% and 1%, 43%, 32%, and 2%, respectively.

In vivo non-invasive high resolution MR-based method for the determination of the elastic modulus of arterial vessels

The mechanical properties of arterial walls have long been recognized to play an essential role in the development and progression of cardiovascular disease (CVD). Early detection of variations in the elastic modulus of arteries would help in monitoring patients at high cardiovascular risk stratifying them according to risk. An in vivo, non-invasive, high resolution MR-phase-contrast based method for the estimation of the time-dependent elastic modulus of healthy arteries was developed, validated in vitro by means of a thin walled silicon rubber tube integrated into an existing MR-compatible flow simulator and used on healthy volunteers. A comparison of the elastic modulus of the silicon tube measured from the MRI-based technique with direct measurements confirmed the method's capability. The repeatability of the method was assessed. Viscoelastic and inertial effects characterizing the dynamic response of arteries in vivo emerged from the comparison of the pressure waveform and the area variation curve over a period. For all the volunteers who took part in the study the elastic modulus was found to be in the range 50-250 kPa, to increase during the rising part of the cycle, and to decrease with decreasing pressure during the downstroke of systole and subsequent diastole.

Lower-limb vascular imaging with acoustic radiation force elastography: demonstration of in vivo feasibility

Acoustic radiation force impulse (ARFI) imaging characterizes the mechanical properties of tissue by measuring displacement resulting from applied ultrasonic radiation force. In this paper, we describe the current status of ARFI imaging for lower-limb vascular applications and present results from both tissue-mimicking phantoms and in vivo experiments. Initial experiments were performed on vascular phantoms constructed with polyvinyl alcohol for basic evaluation of the modality. Multilayer vessels and vessels with compliant occlusions of varying plaque load were evaluated with ARFI imaging techniques. Phantom layers and plaque are well resolved in the ARFI images, with higher contrast than B-mode, demonstrating the ability of ARFI imaging to identify regions of different mechanical properties. Healthy human subjects and those with diagnosed lower-limb peripheral arterial disease were imaged. Proximal and distal vascular walls are well visualized in ARFI images, with higher mean contrast than corresponding B-mode images. ARFI images reveal information not observed by conventional ultrasound and lend confidence to the feasibility of using ARFI imaging during lower-limb vascular workup.

ARFI imaging for noninvasive material characterization of atherosclerosis. Part II: toward in vivo characterization

Seventy percent of cardiovascular disease (CVD) deaths are attributed to atherosclerosis. Despite their clinical significance, nonstenotic atherosclerotic plaques are not effectively detected by conventional atherosclerosis imaging methods. Moreover, conventional imaging methods are insufficient for describing plaque composition, which is relevant to cardiovascular risk assessment. Atherosclerosis imaging technologies capable of improving plaque detection and stratifying cardiovascular risk are needed. Acoustic radiation force impulse (ARFI) ultrasound, a novel imaging method for noninvasively differentiating the mechanical properties of tissue, is demonstrated for in vivo detection of nonstenotic plaques and plaque material assessment in this pilot investigation. In vivo ARFI imaging was performed on four iliac arteries: (1) of a normocholesterolemic pig with no atherosclerosis as a control, (2) of a familial hypercholesterolemic pig with diffuse atherosclerosis, (3) of a normocholesterolemic pig fed a high-fat diet with early atherosclerotic plaques and (4) of a familial hypercholesterolemic pig with diffuse atherosclerosis and a small, minimally occlusive plaque. ARFI results were compared with spatially matched immunohistochemistry, showing correlations between elastin and collagen content and ARFI-derived peak displacement and recovery time parameters. Faster recoveries from ARFI-induced peak displacements and smaller peak displacements were observed in areas of higher elastin and collagen content. Importantly, spatial correlations between tissue content and ARFI results were consistent and observable in large and highly evolved as well as small plaques. ARFI imaging successfully distinguished nonstenotic plaques, while conventional B-mode ultrasound did not. This work validates the potential relevance of ARFI imaging as a noninvasive imaging technology for in vivo detection and material assessment of atherosclerotic plaques.

Improving IVUS palpography by incorporation of motion compensation based on block matching and optical flow

Intravascular ultrasound (IVUS) strain imaging of the luminal layer in coronary arteries, coined as IVUS palpography, utilizes conventional radio frequency (RF) signals acquired at 2 different levels of a compressional load. The signals are cross-correlated to obtain the microscopic tissue displacements, which can be directly translated into local strain of the vessel wall. However, (apparent) tissue motion and nonuniform deformation of the vessel wall, due to catheter wiggling, reduce signal correlation and result in invalid strain estimates. Implications of probe motion were studied on the tissue-mimicking phantom. The measured circumferential tissue displacement and level of the speckle decorrelation amounted to 12 degrees and 0.58, respectively, for the catheter displacement of 456 microm. To compensate for the motion artifacts in IVUS palpography, a novel method based on the feature-based scale-space optical flow (OF), and classical block matching (BM) algorithm, were employed. The computed OF vector and BM displacement fields quantify the amount of local tissue misalignment in consecutive frames. Subsequently, the extracted circumferential displacements are used to realign the signals before strain computation. Motion compensation reduces the RF signal decorrelation and increases the number of valid strain estimates. The advantage of applying the motion correction in IVUS palpography was demonstrated in a midscale validation study on 14 in vivo pullbacks. Both methods substantially increase the number of valid strain estimates in the partial and compounded palpograms. Mean relative improvement in the number of valid strain estimates with motion compensation in comparison to one without motion compensation amounts to 28% and 14%, respectively. Implementation of motion compensation methods boosts the diagnostic value of IVUS palpography.

Relationship between ultrasonic attenuation, size and axial strain parameters for ex vivo atherosclerotic carotid plaque

Many ultrasonic parameters, primarily related to attenuation and scatterer size, have been used to characterize the composition of atherosclerotic plaque tissue. In this study, we combine elastographic (axial strain ratio) and ultrasonic tissue characterization parameters, namely the attenuation coefficient and a scattering parameter associated with an "equivalent" scatterer size to delineate between fibrous, calcified, and lipidic plaque tissue. We present results obtained from 44 ex vivo atherosclerotic plaque specimens obtained after carotid endarterectomy on human patients. Our results in the frequency range 2.5 - 7.5 MHz indicate that softer plaques (with higher values of the strain ratio) are usually associated with larger equivalent scatterer size estimates (200 - 500 microm) and lower values of the attenuation coefficient slope (<1 dB/cm/MHz). On the other hand, stiffer plaques (with lower strain ratio values) are associated with smaller equivalent scatterer size estimates (100 - 200 microm) and higher values of the attenuation coefficient slope (1 - 3 dB/cm/MHz). These results indicate that ultrasonic tissue characterization and strain parameters have the potential to differentiate between different plaque types. These parameters can be estimated from radio-frequency data acquired under in vivo conditions and may help the clinician decide on appropriate interventional techniques.

An inverse method for imaging the local elasticity of atherosclerotic coronary plaques

The rupture of thin-cap fibroatheroma (TCFA) plaques is a major cause of acute coronary events. A TCFA has a trombogenic soft lipid core, shielded from the blood stream by a thin, possibly inflamed, stiff cap. The majority of atherosclerotic plaques resemble a TCFA in terms of overall structural composition, but have a more complex, heterogeneous morphology. An assessment of the material distribution is vital for quantifying the plaque's mechanical stability and for determining the effect of plaque-stabilizing pharmaceutical agents. We describe a new automated inverse elasticity method, intravascular ultrasound (IVUS) modulography, which is capable of reconstructing a heterogeneous Young's modulus distribution. The elastogram (i.e., spatial strain distribution) of the plaque is the input for the method, and is measured using the clinically available technique, IVUS elastography. Our method incorporates a novel divide-and-conquer strategy, allowing the reconstruction of TCFAs as well as heterogeneous plaques with localized regions of soft, weakened tissue. The method was applied to ex vivo elastograms, which were simulated from the cross sections of postmortem human coronary plaques. To demonstrate the clinical feasibility of the method, measured elastograms from human atherosclerotic coronary arteries were analyzed. One elastogram was measured in vitro; the other, in vivo. The method approximated the true Young's modulus distribution of all simulated plaques, while the in vitro reconstruction was in agreement with histology. In conclusion, the IVUS modulography in combination with the IVUS elastography has strong potential to become an all-encompassing modality for detecting plaques, for assessing the information related to their rupture-proneness, and for imaging their heterogeneous elastic material composition.

Reduction of influence of variation in center frequencies of RF echoes on estimation of artery-wall strain

Atherosclerotic change of the arterial wall leads to a significant change in its elasticity. For assessment of elasticity, measurement of arterial wall deformation is required. For motion estimation, correlation techniques are widely used, and we have developed a phase-sensitive correlation method, namely, the phased-tracking method, to measure the regional strain of the arterial wall due to the heartbeat. Although phase-sensitive methods using demodulated complex signals require less computation in comparison with methods using the correlation between RF signals or iterative methods, the displacement estimated by such phase-sensitive methods are biased when the center frequency of the RF echo apparently varies. One of the reasons for the apparent change in the center frequency would be the interference of echoes from scatterers within the wall. In the present study, a method was introduced to reduce the influence of variation in the center frequencies of RF echoes on the estimation of the artery-wall strain when using the phase-sensitive correlation technique. The improvement in the strain estimation by the proposed method was validated using a phantom. The error from the theoretical strain profile and the standard deviation in strain estimated by the proposed method were 12.0% and 14.1%, respectively, significantly smaller than those (23.7% and 46.2%) obtained by the conventional phase-sensitive correlation method. Furthermore, in the preliminary in vitro experimental results, the strain distribution of the arterial wall well corresponded with pathology, i.e., the region with calcified tissue showed very small strain, and the region almost homogeneously composed of smooth muscle and collagen showed relatively larger strain and clear strain decay with respect to the radial distance from the lumen.

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.

Simulation and validation of arterial ultrasound imaging and blood flow

We reviewed the simulation and validation of arterial ultrasound imaging and blood flow assessment. The physical process of ultrasound imaging and measurement is complex, especially in disease. Simulation of physiological flow in a phantom with tissue equivalence of soft tissue, vessel wall and blood is now achievable. Outstanding issues are concerned with production of anatomical models, simulation of arterial disease, refinement of blood mimics to account for non-Newtonian behavior and validation of velocity measurements against an independent technique such as particle image velocimetry. String and belt phantoms offer simplicity of design, especially for evaluation of velocity estimators, and have a role as portable test objects. Electronic injection and vibrating test objects produce nonphysiologic Doppler signals, and their role is limited. Computational models of the ultrasound imaging and measurement process offer considerable flexibility in their ability to alter multiple parameters of both the propagation medium and ultrasound instrument. For these models, outstanding issues are concerned with the inclusion of different tissue types, multilayer arteries, inhomogeneous tissues and diseased tissues.

Robust principal component analysis and clustering methods for automated classification of tissue response to ARFI excitation

We introduce a new method for automatic classification of acoustic radiation force impulse (ARFI) displacement profiles using what have been termed "robust" methods for principal component analysis (PCA) and clustering. Unlike classical approaches, the robust methods are less sensitive to high variance outlier profiles and require no a priori information regarding expected tissue response to ARFI excitation. We first validate our methods using synthetic data with additive noise and/or outlier curves. Second, the robust techniques are applied to classifying ARFI displacement profiles acquired in an atherosclerotic familial hypercholesterolemic (FH) pig iliac artery in vivo. The in-vivo classification results are compared with parametric ARFI images showing peak induced displacement and time to 67% recovery and to spatially correlated immunohistochemistry. Our results support that robust techniques outperform conventional PCA and clustering approaches to classification when ARFI data are inclusive of low to relatively high noise levels (up to 5 dB average signal-to-noise [SNR] to amplitude) but no outliers: for example, 99.53% correct for robust techniques vs. 97.75% correct for the classical approach. The robust techniques also perform better than conventional approaches when ARFI data are inclusive of moderately high noise levels (10 dB average SNR to amplitude) in addition to a high concentration of outlier displacement profiles (10% outlier content): for example, 99.87% correct for robust techniques vs. 33.33% correct for the classical approach. This work suggests that automatic identification of tissue structures exhibiting similar displacement responses to ARFI excitation is possible, even in the context of outlier profiles. Moreover, this work represents an important first step toward automatic correlation of ARFI data to spatially matched immunohistochemistry.

Contrast-enhanced intravascular ultrasound: combining morphology with activity-based assessment of plaque vulnerability

Acute coronary syndromes are the result of coronary plaque rupture in the majority of cases. Available diagnostic techniques that focus on the early detection of plaques that are prone to rupture are still limited. Increased neovascularization in the vasa vasorum of the atherosclerotic plaque has been identified recently as a common feature of inflammation and plaque vulnerability. Microbubbles, which have been used for ultrasound imaging, can be used to trace neovascularization. We present recent advances in contrast agents and contrast-enhanced intravascular ultrasound that may be used for the detection of vasa vasorum, including fundamental and harmonic contrast imaging. Identification of vasa vasorum proliferation in atherosclerotic plaques presents important clinical implications; in particular it could provide a means to detect vulnerability in vivo, thereby guiding targeted treatments.

Calculation of arterial wall temperature in atherosclerotic arteries: effect of pulsatile flow, arterial geometry, and plaque structure

Background

This paper presents calculations of the temperature distribution in an atherosclerotic plaque experiencing an inflammatory process; it analyzes the presence of hot spots in the plaque region and their relationship to blood flow, arterial geometry, and inflammatory cell distribution. Determination of the plaque temperature has become an important topic because plaques showing a temperature inhomogeneity have a higher likelihood of rupture. As a result, monitoring plaque temperature and knowing the factors affecting it can help in the prevention of sudden rupture.

Methods

The transient temperature profile in inflamed atherosclerotic plaques is calculated by solving an energy equation and the Navier-Stokes equations in 2D idealized arterial models of a bending artery and an arterial bifurcation. For obtaining the numerical solution, the commercial package COMSOL 3.2 was used. The calculations correspond to a parametric study where arterial type and size, as well as plaque geometry and composition, are varied. These calculations are used to analyze the contribution of different factors affecting arterial wall temperature measurements. The main factors considered are the metabolic heat production of inflammatory cells, atherosclerotic plaque length l_p, inflammatory cell layer length l_mp, and inflammatory cell layer thickness d_mp.

Results

The calculations indicate that the best location to perform the temperature measurement is at the back region of the plaque (0.5 ≤ l/l_p ≤ 0.7). The location of the maximum temperature, or hot spot, at the plaque surface can move during the cardiac cycle depending on the arterial geometry and is a direct result of the blood flow pattern. For the bending artery, the hot spot moves 0.6 millimeters along the longitudinal direction; for the arterial bifurcation, the hot spot is concentrated at a single location due to the flow recirculation observed at both ends of the plaque. Focusing on the thermal history of different points selected at the plaque surface, it is seen that during the cardiac cycle the temperature at a point located at l/l_p = 0.7 can change between 0.5 and 0.1 degrees Celsius for the bending artery, while no significant variation is observed in the arterial bifurcation. Calculations performed for different values of inflammatory cell layer thickness d_mp indicate the same behavior reported experimentally; that corresponds to an increase in the maximum temperature observed, which for the bending artery ranges from 0.6 to 2.0 degrees Celsius, for d_mp = 25 and 100 micrometers, respectively.

Conclusion

The results indicate that direct temperature measurements should be taken (1) as close as possible to the plaque/lumen surface, as the calculations show a significant drop in temperature within 120 micrometers from the plaque surface; (2) in the presence of blood flow, temperature measurement should be performed in the downstream edge of the plaque, as it shows higher temperature independently of the arterial geometry; and (3) it is necessary to perform measurements at a sampling rate that is higher than the cardiac cycle; the measurement should be extended through several cardiac cycles, as variations of up to 0.7 degrees Celsius were observed at l/l_p = 0.7 for the bending artery.

ARFI imaging for noninvasive material characterization of atherosclerosis

Cardiovascular disease (CVD) is the leading cause of death in the United States, with 70% of CVD mortalities the result of sequelae of atherosclerosis. An urgent need for enhanced delineation of vulnerable plaques has catalyzed the development of novel atherosclerosis imaging strategies that use X-ray computed tomography, magnetic resonance and ultrasound modalities. As suggested by the pathophysiology of plaque development and progression to vulnerability, insight to the focal material, i.e., mechanical, properties of arterial walls and plaques may enhance atherosclerosis characterization. We present acoustic radiation force impulse (ARFI) ultrasound in application to mechanically characterizing a raised focal atherosclerotic plaque in an iliac artery extracted from a relevant pig model. ARFI results are correlated to matched immunohistochemistry, indicating elastin and collagen composition. In regions of degraded elastin, slower recovery rates from peak ARFI-induced displacements were observed. In regions of collagen deposition, lower ARFI-induced displacements were achieved. This work demonstrates ARFI for characterizing the material nature of an atherosclerotic plaque.