Anthropomorphic breast phantoms for testing elastography systems

Review of imaging test phantoms

Significance

Photoacoustic tomography has emerged as a prominent medical imaging technique that leverages its hybrid nature to provide deep penetration, high resolution, and exceptional optical contrast with notable applications in early cancer detection, functional brain imaging, drug delivery monitoring, and guiding interventional procedures. Test phantoms are pivotal in accelerating technology development and commercialization, specifically in photoacoustic (PA) imaging, and can be optimized to achieve significant advancements in PA imaging capabilities.

Aim

The analysis of material properties, structural characteristics, and manufacturing methodologies of test phantoms from existing imaging technologies provides valuable insights into their applicability to PA imaging. This investigation enables a deeper understanding of how phantoms can be effectively employed in the context of PA imaging.

Approach

Three primary categories of test phantoms (simple, intermediate, and advanced) have been developed to differentiate complexity and manufacturing requirements. In addition, four sub-categories (tube/channel, block, test target, and naturally occurring phantoms) have been identified to encompass the structural variations within these categories, resulting in a comprehensive classification system for test phantoms.

Results

Based on a thorough examination of literature and studies on phantoms in various imaging modalities, proposals have been put forth for the development of multiple PA-capable phantoms, encompassing considerations related to the material composition, structural design, and specific applications within each sub-category.

Conclusions

The advancement of novel and sophisticated test phantoms within each sub-category is poised to foster substantial progress in both the commercialization and development of PA imaging. Moreover, the continued refinement of test phantoms will enable the exploration of new applications and use cases for PA imaging.

Tissue-Mimicking Materials for Ultrasound-Guided Needle Intervention Phantoms: A Comprehensive Review

Ultrasound-guided needle interventions are common procedures in medicine, and tissue-mimicking phantoms are widely used for simulation training to bridge the gap between theory and clinical practice in a controlled environment. This review assesses tissue-mimicking materials from 24 studies as candidates for a high-fidelity ultrasound phantom, including methods for evaluating relevant acoustic and mechanical properties and to what extent the reported materials mimic the superficial layers of biological tissue. Speed of sound, acoustic attenuation, Young's modulus, hardness, needle interaction forces, training efficiency and material limitations were systematically evaluated. Although gelatin and agar have the closest acoustic values to tissue, mechanical properties are limited, and strict storage protocols must be employed to counteract dehydration and microbial growth. Polyvinyl chloride (PVC) has superior mechanical properties and is a suitable alternative if durability is desired and some ultrasound realism to human tissue may be sacrificed. Polyvinyl alcohol (PVA), while also requiring hydration, performs well across all categories. Furthermore, we propose a framework for the evaluation of future ultrasound-guided needle intervention tissue phantoms to increase the fidelity of training programs and thereby improve clinical performance.

Nonlinear Characterization of Tissue Viscoelasticity With Acoustoelastic Attenuation of Shear Waves

Shear-wave elastography (SWE) measures shear-wave speed (SWS), which is related to the underlying shear modulus of soft tissue. SWS in soft tissue changes depending on the amount of external strain that soft tissue is subjected to due to the acoustoelastic (AE) phenomenon. In the literature, variations of SWS as a function of applied uniaxial strain were used for nonlinear characterization, assuming soft tissues to be elastic, although soft tissues are indeed viscoelastic in nature. Hence, nonlinear characterization using SWS alone is insufficient. In this work, we use SWS together with shear-wave attenuation (SWA) during incremental quasi-static compressions in order to derive biomechanical characterization based on the AE theory in terms of well-defined storage and loss moduli. As part of this study, we also quantify the effect of applied strain on measurements of SWS and SWA since such confounding effects need to be taken into account when using SWS and/or SWA, e.g., for staging a disease state, while such effects can also serve as an additional imaging biomarker. Our results from tissue-mimicking phantoms with varying oil percentages and ex vivo porcine liver experiments demonstrate the feasibility of our proposed methods. In both experiments, SWA was observed to decrease with applied strain. For 10% compression in ex vivo livers, shear-wave attenuation decreased, on average, by 28% (93 Np/m), while SWS increased, on average, by 20% (0.26 m/s).

Projection-based stereolithography for direct 3D printing of heterogeneous ultrasound phantoms

Modern ultrasound (US) imaging is increasing its clinical impact, particularly with the introduction of US-based quantitative imaging biomarkers. Continued development and validation of such novel imaging approaches requires imaging phantoms that recapitulate the underlying anatomy and pathology of interest. However, current US phantom designs are generally too simplistic to emulate the structure and variability of the human body. Therefore, there is a need to create a platform that is capable of generating well-characterized phantoms that can mimic the basic anatomical, functional, and mechanical properties of native tissues and pathologies. Using a 3D-printing technique based on stereolithography, we fabricated US phantoms using soft materials in a single fabrication session, without the need for material casting or back-filling. With this technique, we induced variable levels of stable US backscatter in our printed materials in anatomically relevant 3D patterns. Additionally, we controlled phantom stiffness from 7 to >120 kPa at the voxel level to generate isotropic and anisotropic phantoms for elasticity imaging. Lastly, we demonstrated the fabrication of channels with diameters as small as 60 micrometers and with complex geometry (e.g., tortuosity) capable of supporting blood-mimicking fluid flow. Collectively, these results show that projection-based stereolithography allows for customizable fabrication of complex US phantoms.

In silicoevaluation and optimisation of magnetic resonance elastography of the liver

Objective.Magnetic resonance elastography (MRE) is widely adopted as a biomarker of liver fibrosis. However,in vivoMRE accuracy is difficult to assess.Approach.Finite element model (FEM) simulation was employed to evaluate liver MRE accuracy and inform methodological optimisation. MRE data was simulated in a 3D FEM of the human torso including the liver, and compared with spin-echo echo-planar imaging MRE acquisitions. The simulated MRE results were compared with the ground truth magnitude of the complex shear modulus (∣G*∣) for varying: (1) ground truth liver ∣G*∣; (2) simulated imaging resolution; (3) added noise; (4) data smoothing. Motion and strain-based signal-to-noise (SNR) metrics were evaluated on the simulated data as a means to select higher-quality voxels for preparation of acquired MRE summary statistics of ∣G*∣.Main results.The simulated MRE accuracy for a given ground truth ∣G*∣ was found to be a function of imaging resolution, motion-SNR and smoothing. At typical imaging resolutions, it was found that due to under-sampling of the MRE wave-field, combined with motion-related noise, the reconstructed simulated ∣G*∣ could contain errors on the scale of the difference between liver fibrosis stages, e.g. 54% error for ground truth ∣G*∣ = 1 kPa. Optimum imaging resolutions were identified for given ground truth ∣G*∣ and motion-SNR levels.Significance.This study provides important knowledge on the accuracy and optimisation of liver MRE. For example, for motion-SNR ≤ 5, to distinguish between liver ∣G*∣ of 2 and 3 kPa (i.e. early-stage liver fibrosis) it was predicted that the optimum isotropic voxel size is 4-6 mm.

Low-Cost and Easily Fabricated Ultrasound-Guided Breast Phantom for Breast Biopsy Training

We aimed to develop an inexpensive and easy-to-fabricate gelatin-based training phantom for improving the breast biopsy skill and confidence level of residents. Young’s modulus and acoustic properties of the gelatin tissue phantom and simulated tumors were investigated. Six residents were requested to evaluate the effectiveness of the breast phantom. The results showed that 83% (n = 5) of the participants agreed that the ultrasound image quality produced by the breast phantom was excellent or good. Only 17% (n = 1) of the participants claimed that there was room for improvement for the haptic feedback they received during the placement of the core needle into the breast phantom. The mean pre-instructional score was 17% (SD 17%) for all participants. The mean post-instructional score was 83% (SD 17%), giving an overall improvement of 67%. In conclusion, the mean needle biopsy skill and confidence levels of the participants substantially increased through simulation training on our breast phantom. The participants’ feedback showed the phantom is sufficiently realistic in terms of ultrasound imaging and haptic feedback during needle insertion; thus, the training outcome can be linked to the performance of residents when they perform a live biopsy.

Bayesian Approach for a Robust Speed-of-Sound Reconstruction Using Pulse-Echo Ultrasound

Computed ultrasound tomography in echo mode (CUTE) is a promising ultrasound (US) based multi-modal technique that allows to image the spatial distribution of speed of sound (SoS) inside tissue using hand-held pulse-echo US. It is based on measuring the phase shift of echoes when detected under varying steering angles. The SoS is then reconstructed using a regularized inversion of a forward model that describes the relation between the SoS and echo phase shift. Promising results were obtained in phantoms when using a Tikhonov-type regularization of the spatial gradient (SG) of SoS. In-vivo, however, clutter and aberration lead to an increased phase noise. In many subjects, this phase noise causes strong artifacts in the SoS image when using the SG regularization. To solve this shortcoming, we propose to use a Bayesian framework for the inverse calculation, which includes a priori statistical properties of the spatial distribution of the SoS to avoid noise-related artifacts in the SoS images. In this study, the a priori model is based on segmenting the B-Mode image. We show in a simulation and phantom study that this approach leads to SoS images that are much more stable against phase noise compared to the SG regularization. In a preliminary in-vivo study, a reproducibility in the range of 10 ms^-1 was achieved when imaging the SoS of a volunteer's liver from different scanning locations. These results demonstrate the diagnostic potential of CUTE for example for the staging of fatty liver disease.

Acoustic impedance measurement of tissue mimicking materials by using scanning acoustic microscopy

Tissue-mimicking materials (TMMs) play a key role in the quality assurance of ultrasound diagnostic equipment and should have acoustic properties similar to human tissues. We propose a method to quantify the acoustic properties of TMM samples through the use of an 80 MHz Scanning Acoustic Microscopy (SAM), which provides micrometer resolution and fast data recording. We produced breast TMM samples in varying compositions that resulted in acoustic impedance values in the range of 1.373 ± 0.031 and 1.707 ± 0.036 MRayl. Additionally, liver TMM and blood mimicking fluid (BMF) samples were prepared that had acoustic impedance values of 1.693 ± 0.085 MRayl and 1.624 ± 0.006 MRayl, respectively. The characterization of the TMMs by SAM may provide reproducible and uniform acoustic reference data for tissue substitutes in a single-run microscopy experiment.

Improved forward model for quantitative pulse-echo speed-of-sound imaging

Computed ultrasound tomography in echo mode (CUTE) allows determining the spatial distribution of speed-of-sound (SoS) inside tissue using handheld pulse-echo ultrasound (US). This technique is based on measuring the changing phase of beamformed echoes obtained under varying transmit (Tx) and/or receive (Rx) steering angles. The SoS is reconstructed by inverting a forward model describing how the spatial distribution of SoS is related to the spatial distribution of the echo phase shift. Thanks to the straight-ray approximation, this forward model is linear and can be inverted in real-time when implemented in a state-of-the art system. Here we demonstrate that the forward model must contain two features that were not taken into account so far: (a) the phase shift must be detected between pairs of Tx and Rx angles that are centred around a set of common mid-angles, and (b) it must account for an additional phase shift induced by the offset of the reconstructed position of echoes. In a phantom study mimicking hepatic and cancer imaging, we show that both features are required to accurately predict echo phase shift among different phantom geometries, and that substantially improved quantitative SoS images are obtained compared to the model that has been used so far. The importance of the new model is corroborated by a preliminary volunteer result.

Mechanical characterisation of an organic phantom candidate for breast tissue

The aim of this study is to analyse the mechanical properties of agarose, which can be used as a mechanical phantom for breast tissues. In general, tissue mimicking materials may be used to achieve a better understanding of the structure and properties of tissues and organs; this work shares these objectives. The phantom can be used as a tissue surrogate with realistic mechanical behaviour for biomechanical applications. To validate agarose as a suitable mechanical phantom for breast tissues, indentation tests were performed in homogeneous, rectangular agarose blocks. Blocks with different agarose concentrations were moulded and tested. An estimation of the material stiffness was then compared with experimental data on different breast tissues’ types found in literature. The phantom stiffness increased consistently with agarose concentration and stress. The results show that agarose-based mechanical phantoms of stiffer tissues require higher agarose concentrations (0.5% and 0.6%). In contrast, normal tissues can be mimicked with 0.3% and 0.4% of agarose. In addition, it was observed that preconditioning affects the mechanical properties of the gel, as it had already been shown in literature for breast tissues.

Characterizing mechanical and medical imaging properties of polyvinyl chloride-based tissue-mimicking materials

Polyvinyl chloride (PVC) is a commonly used tissue‐mimicking material (TMM) for phantom construction using 3D printing technology. PVC‐based TMMs consist of a mixture of PVC powder and dioctyl terephthalate as a softener. In order to allow the clinical use of a PVC‐based phantom use across CT and magnetic resonance imaging (MRI) imaging platforms, we evaluated the mechanical and physical imaging characteristics of ten PVC samples. The samples were made with different PVC‐softener ratios to optimize phantom bioequivalence with physiologic human tissue. Phantom imaging characteristics, including computed tomography (CT) number, MRI relaxation time, and mechanical properties (e.g., Poisson’s ratio and elastic modulus) were quantified. CT number varied over a range of approximately −10 to 110 HU. The relaxation times of the T1‐weighted and T2‐weighted images were 206.81 ± 17.50 and 20.22 ± 5.74 ms, respectively. Tensile testing was performed to evaluate mechanical properties on the three PVC samples that were closest to human tissue. The elastic moduli for these samples ranged 7.000–12.376 MPa, and Poisson’s ratios were 0.604–0.644. After physical and imaging characterization of the various PVC‐based phantoms, we successfully produced a bioequivalent phantom compatible with multimodal imaging platforms for machine calibration and image optimization/benchmarking. By combining PVC with 3D printing technologies, it is possible to construct imaging phantoms simulating human anatomies with tissue equivalency.

3D-printed breast phantom for multi-purpose and multi-modality imaging

Background

Breast imaging technology plays an important role in breast cancer planning and treatment. Recently, three-dimensional (3D) printing technology has become a trending issue in phantom constructions for medical applications, with its advantages of being customizable and cost-efficient. However, there is no current practice in the field of multi-purpose breast phantom for quality control (QC) in multi-modalities imaging. The purpose of this study was to fabricate a multi-purpose breast phantom with tissue-equivalent materials via a 3D printing technique for QC in multi-modalities imaging.

Methods

We used polyvinyl chloride (PVC) based materials and a 3D printing technique to construct a breast phantom. The phantom incorporates structures imaged in the female breast such as microcalcifications, fiber lesions, and tumors with different sizes. Moreover, the phantom was used to assess the sensitivity of lesion detection, depth resolution, and detectability thresholds with different imaging modalities. Phantom tissue equivalent properties were determined using computed tomography (CT) attenuation [Hounsfield unit (HU)] and magnetic resonance imaging (MRI) relaxation times.

Results

The 3D-printed breast phantom had an average background value of 36.2 HU, which is close to that of glandular breast tissue (40 HU). T1 and T2 relaxation times had an average relaxation time of 206.81±17.50 and 20.22±5.74 ms, respectively. Mammographic imaging had improved detection of microcalcification compared with ultrasound and MRI with multiple sequences [T1WI, T2WI and short inversion time inversion recovery (STIR)]. Soft-tissue lesion detection and cylindrical tumor contrast were superior with mammography and MRI compared to ultrasound. Hemispherical tumor detection was similar regardless of the imaging modality used.

Conclusions

We developed a multi-purpose breast phantom using a 3D printing technique and determined its value for multi-modal breast imaging studies.

Image reconstruction with the Heaviside equation in photoacoustic tomography accounting for dispersive acoustic media

A challenging issue in photoacoustic biomedical imaging is to take into account the presence of dispersive acoustic media, since these are prone to induce amplitude attenuation and scattering of the photoacoustic frequency components. These perturbations are largely the cause for which the photoacoustic tomographic image reconstruction from projections lacks a plane-wave transport formalism. Attending this problem, we further develop an analytic formalism of the transport and its numerical implementation accounting for dispersive acoustic media. We differentiate three variations of an acoustically perturbing media. Our object of interest is a numerical description of the light absorption map of a coronal human breast image. Then, we analyze conditions for which the propagation of photoacoustic perturbations can obey the generalized Heaviside telegraph equation. In addition, we provide a study of the causality consistency of the wave propagation models. We observe transport implications due to the presence of dispersive acoustic media and derive model adjustments that include attenuation and diffusion approximations within the two-dimensional forward problem. Next, we restore the inverse problem description with the deduced perturbation components. Finally, we solve the nonlinear inverse problem with a numerical strategy for a filtered backprojection reconstruction. At a stage prior to the image reconstruction, we compensate for the effect of acoustic attenuation and diffusion to calculate the inversions of the wave perturbations located within the projections. In this way, we manage to significantly reduce reconstruction artifacts. In consequence, we prevent the use of some additional image processing of noise reduction. We demonstrate a feasible strategy on how to solve the stated nonlinear inverse problem of photoacoustic tomography accounting for dispersive acoustic media. In particular, we emphasize efforts to achieve an analytical description, and thus an algorithm is placed, for imaged sound perturbations to be cleaned from acoustic scattering in a simplified manner.

Chemical Items Used for Preparing Tissue-Mimicking Material of Wall-Less Flow Phantom for Doppler Ultrasound Imaging

The wall-less flow phantoms with recognized acoustic features (attenuation and speed of sound), interior properties, and dimensions of tissue were prepared, calibrated, and characterized of Doppler ultrasound scanning demands tissue-mimicking materials (TMMs). TMM phantoms are commercially available and ready-made for medical ultrasound applications. Furthermore, the commercial TMM phantoms are proper for ultrasound purpose or estimation of diagnostic imaging techniques according to the chemical materials used for its preparation. However, preparing a desirable TMM for wall-less flow phantom using a specific chemical material according to the specific applications is required for different flow. In this review, TMM and wall-less flow phantoms prepared using different chemical materials and methods were described. The chemical materials used in Doppler ultrasound TMM and wall-less flow phantoms fabricated over the previous decades were of high interest in this review.

Supersonic transient magnetic resonance elastography for quantitative assessment of tissue elasticity

Non-invasive, quantitative methods to assess the properties of biological tissues are needed for many therapeutic and tissue engineering applications. Magnetic resonance elastography (MRE) has historically relied on external vibration to generate periodic shear waves. In order to focally assess a biomaterial or to monitor the response to ablative therapy, the interrogation of a specific region of interest by a focused beam is desirable and transient MRE (t-MRE) techniques have previously been developed to accomplish this goal. Also, strategies employing a series of discrete ultrasound pulses directed to increasing depths along a single line-of-sight have been designed to generate a quasi-planar shear wave. Such 'supersonic' excitations have been applied for ultrasound elasticity measurements. The resulting shear wave is higher in amplitude than that generated from a single excitation and the properties of the media are simply visualized and quantified due to the quasi-planar wave geometry and the opportunity to generate the wave at the site of interest. Here for the first time, we extend the application of supersonic methods by developing a protocol for supersonic transient magnetic resonance elastography (sst-MRE) using an MR-guided focused ultrasound system capable of therapeutic ablation. We apply the new protocol to quantify tissue elasticity in vitro using biologically-relevant inclusions and tissue-mimicking phantoms, compare the results with elasticity maps acquired with ultrasound shear wave elasticity imaging (US-SWEI), and validate both methods with mechanical testing. We found that a modified time-of-flight (TOF) method efficiently quantified shear modulus from sst-MRE data, and both the TOF and local inversion methods result in similar maps based on US-SWEI. With a three-pulse excitation, the proposed sst-MRE protocol was capable of visualizing quasi-planar shear waves propagating away from the excitation location and detecting differences in shear modulus of 1 kPa. The techniques demonstrated here have potential application in real-time in vivo lesion detection and monitoring, with particular significance for image-guided interventions.

Development of a training phantom for compression breast elastography-comparison of various elastography systems and numerical simulations

The elastic properties of tissue are related to tissue composition and pathological changes. It has been observed that many pathological processes increase the elastic modulus of soft tissue compared to normal. Ultrasound compression elastography is a method of characterization of elastic properties that has been the focus of many research efforts in the last two decades. In medical radiology, compression elastography is provided as an additional tool with ultrasound B-mode in the existing scanners, and the combined features of elastography and echography act as a promising diagnostic method in breast cancer detection. However, the full capability of the ultrasound elastography technique together with B-mode has not been utilized by novice radiologists due to the nonavailability of suitable, appropriately designed tissue-mimicking phantoms. Since different commercially available ultrasound elastographic scanners follow their own unique protocols, training novice radiologists is becoming cumbersome. The main focus of this work is to develop a tissue-like agar-based phantom, which mimics breast tissue with common abnormal lesions like fibroadenoma and invasive ductal carcinoma in a clinically perceived way and compares the sonographic and elastographic appearances using different commercially available systems. In addition, the developed phantoms are simulated using the finite-element method, and ideal strain images are generated. Strain images from experiment and simulation are compared based on image contrast parameters, namely contrast transfer efficiency (CTE) and observed strain, and they are in good agreement. The strain image contrast of malignant inclusions is significantly improved compared to benign inclusions, and the trend of CTE is similar for all elastographic scanners under investigation.

Posterior Shoulder Capsules Are Thicker and Stiffer in the Throwing Shoulders of Healthy College Baseball Players: A Quantitative Assessment Using Shear-Wave Ultrasound Elastography

BACKGROUND

Posterior and posteroinferior capsules in the shoulder joints of throwing athletes have been reported to be thicker in throwing than nonthrowing shoulders, and this has a relationship to glenohumeral internal rotation deficit (GIRD). However, the stiffness of these thickened capsules has not been reported. Shear-wave ultrasound elastography is a new technology that can measure tissue elasticity quantitatively.

HYPOTHESIS

The posterior and posteroinferior capsules are stiffer as well as thicker in the throwing shoulders of baseball players than in their nonthrowing shoulders. The thickness and elasticity of these capsules are inversely correlated with glenohumeral internal rotation.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Forty-five male college baseball players were examined. The thickness and elasticity of the posterior capsule beneath the infraspinatus and the posteroinferior capsule beneath the teres minor were measured using an ultrasonic device equipped with shear-wave elastographic technology. Glenohumeral internal rotation at 90° of shoulder abduction and humeral retrotorsion were also measured.

RESULTS

The mean thickness and elasticity of the posterior capsule were significantly greater for the throwing compared with the nonthrowing shoulder (thickness: 1.34 vs 1.04 mm, respectively; elasticity: 40.0 vs 32.2 kPa, respectively; P < .001 for both). The mean thickness and elasticity of the posteroinferior capsule were also significantly greater in the throwing compared with the nonthrowing shoulder (thickness: 1.40 vs 1.04 mm, respectively; elasticity: 39.4 vs 31.6 kPa, respectively; P < .001 for both). After correcting the range of motion for bilateral differences in retrotorsion, correlation coefficients showed that posterior capsule thickness and elasticity (Pearson r = -0.43 and -0.56, respectively; P < .001 for both) and posteroinferior capsule thickness and elasticity (Pearson r = -0.51 and -0.52, respectively; P < .001 for both) were negatively correlated with the corrected glenohumeral internal rotation. Bilateral differences in posterior and posteroinferior capsule elasticity correlated with bilateral differences in the corrected glenohumeral internal rotation (Pearson r = 0.46 [P = .0015] and 0.48 [P < .001], respectively), whereas bilateral differences in posterior and posteroinferior capsule thickness did not (Pearson r = -0.13 [P = .38] and 0.17 [P = .28], respectively).

CONCLUSION

The posterior and posteroinferior capsules were stiffer as well as thicker in the throwing shoulder of college baseball players compared with the nonthrowing shoulder. Posterior capsule elasticity appeared to have a greater effect on GIRD than did posterior capsule thickness. This technology could be used as a noninvasive screening method for throwing athletes to identify players at potential risk of shoulder injuries.

Mechanical induction of the tumorigenic β-catenin pathway by tumour growth pressure

The tumour microenvironment may contribute to tumorigenesis owing to mechanical forces such as fibrotic stiffness or mechanical pressure caused by the expansion of hyper-proliferative cells. Here we explore the contribution of the mechanical pressure exerted by tumour growth onto non-tumorous adjacent epithelium. In the early stage of mouse colon tumour development in the Notch(+)Apc(+/1638N) mouse model, we observed mechanistic pressure stress in the non-tumorous epithelial cells caused by hyper-proliferative adjacent crypts overexpressing active Notch, which is associated with increased Ret and β-catenin signalling. We thus developed a method that allows the delivery of a defined mechanical pressure in vivo, by subcutaneously inserting a magnet close to the mouse colon. The implanted magnet generated a magnetic force on ultra-magnetic liposomes, stabilized in the mesenchymal cells of the connective tissue surrounding colonic crypts after intravenous injection. The magnetically induced pressure quantitatively mimicked the endogenous early tumour growth stress in the order of 1,200 Pa, without affecting tissue stiffness, as monitored by ultrasound strain imaging and shear wave elastography. The exertion of pressure mimicking that of tumour growth led to rapid Ret activation and downstream phosphorylation of β-catenin on Tyr654, imparing its interaction with the E-cadherin in adherens junctions, and which was followed by β-catenin nuclear translocation after 15 days. As a consequence, increased expression of β-catenin-target genes was observed at 1 month, together with crypt enlargement accompanying the formation of early tumorous aberrant crypt foci. Mechanical activation of the tumorigenic β-catenin pathway suggests unexplored modes of tumour propagation based on mechanical signalling pathways in healthy epithelial cells surrounding the tumour, which may contribute to tumour heterogeneity.

4-D ultrafast shear-wave imaging

Over the last ten years, shear wave elastography (SWE) has seen considerable development and is now routinely used in clinics to provide mechanical characterization of tissues to improve diagnosis. The most advanced technique relies on the use of an ultrafast scanner to generate and image shear waves in real time in a 2-D plane at several thousands of frames per second. We have recently introduced 3-D ultrafast ultrasound imaging to acquire with matrix probes the 3-D propagation of shear waves generated by a dedicated radiation pressure transducer in a single acquisition. In this study, we demonstrate 3-D SWE based on ultrafast volumetric imaging in a clinically applicable configuration. A 32 × 32 matrix phased array driven by a customized, programmable, 1024-channel ultrasound system was designed to perform 4-D shear-wave imaging. A matrix phased array was used to generate and control in 3-D the shear waves inside the medium using the acoustic radiation force. The same matrix array was used with 3-D coherent plane wave compounding to perform high-quality ultrafast imaging of the shear wave propagation. Volumetric ultrafast acquisitions were then beamformed in 3-D using a delay-and-sum algorithm. 3-D volumetric maps of the shear modulus were reconstructed using a time-of-flight algorithm based on local multiscale cross-correlation of shear wave profiles in the three main directions using directional filters. Results are first presented in an isotropic homogeneous and elastic breast phantom. Then, a full 3-D stiffness reconstruction of the breast was performed in vivo on healthy volunteers. This new full 3-D ultrafast ultrasound system paves the way toward real-time 3-D SWE.

Mechanical induction of the tumorigenic β-catenin pathway by tumour growth pressure

The tumour microenvironment may contribute to tumorigenesis owing to mechanical forces such as fibrotic stiffness or mechanical pressure caused by the expansion of hyper-proliferative cells. Here we explore the contribution of the mechanical pressure exerted by tumour growth onto non-tumorous adjacent epithelium. In the early stage of mouse colon tumour development in the Notch(+)Apc(+/1638N) mouse model, we observed mechanistic pressure stress in the non-tumorous epithelial cells caused by hyper-proliferative adjacent crypts overexpressing active Notch, which is associated with increased Ret and β-catenin signalling. We thus developed a method that allows the delivery of a defined mechanical pressure in vivo, by subcutaneously inserting a magnet close to the mouse colon. The implanted magnet generated a magnetic force on ultra-magnetic liposomes, stabilized in the mesenchymal cells of the connective tissue surrounding colonic crypts after intravenous injection. The magnetically induced pressure quantitatively mimicked the endogenous early tumour growth stress in the order of 1,200 Pa, without affecting tissue stiffness, as monitored by ultrasound strain imaging and shear wave elastography. The exertion of pressure mimicking that of tumour growth led to rapid Ret activation and downstream phosphorylation of β-catenin on Tyr654, imparing its interaction with the E-cadherin in adherens junctions, and which was followed by β-catenin nuclear translocation after 15 days. As a consequence, increased expression of β-catenin-target genes was observed at 1 month, together with crypt enlargement accompanying the formation of early tumorous aberrant crypt foci. Mechanical activation of the tumorigenic β-catenin pathway suggests unexplored modes of tumour propagation based on mechanical signalling pathways in healthy epithelial cells surrounding the tumour, which may contribute to tumour heterogeneity.

Breast ultrasound despeckling using anisotropic diffusion guided by texture descriptors

Breast ultrasound (BUS) is considered the most important adjunct method to mammography for diagnosing cancer. However, this image modality suffers from an intrinsic artifact called speckle noise, which degrades spatial and contrast resolution and obscures the screened anatomy. Hence, it is necessary to reduce speckle artifacts before performing image analysis by means of computer-aided diagnosis systems, for example. In addition, the trade-off between smoothing level and preservation of lesion contour details should be addressed by speckle reduction schemes. In this scenario, we propose a BUS despeckling method based on anisotropic diffusion guided by Log-Gabor filters (ADLG). Because we assume that different breast tissues have distinct textures, in our approach we perform a multichannel decomposition of the BUS image using Log-Gabor filters. Next, the conduction coefficient of anisotropic diffusion filtering is computed using texture responses instead of intensity values as stated originally. The proposed algorithm is validated using both synthetic and real breast data sets, with 900 and 50 images, respectively. The performance measures are compared with four existing speckle reduction schemes based on anisotropic diffusion: conventional anisotropic diffusion filtering (CADF), speckle-reducing anisotropic diffusion (SRAD), texture-oriented anisotropic diffusion (TOAD), and interference-based speckle filtering followed by anisotropic diffusion (ISFAD). The validity metrics are the Pratt's figure of merit, for synthetic images, and the mean radial distance (in pixels), for real sonographies. Figure of merit and mean radial distance indices should tend toward '1' and '0', respectively, to indicate adequate edge preservation. The results suggest that ADLG outperforms the four speckle removal filters compared with respect to simulated and real BUS images. For each method--ADLG, CADF, SRAD, TOAD and ISFAD--the figure of merit median values are 0.83, 0.40, 0.39, 0.51 and 0.59, and the mean radial distance median results are 4.19, 6.29, 6.39, 6.43 and 5.88.

Silicone breast phantoms for elastographic imaging evaluation

PURPOSE

Breast cancer is a major public health issue for women, and early detection significantly increases survival rate. Currently, there is increased research interest in elastographic soft-tissue imaging techniques based on the correlation between pathology and mechanical stiffness. Anthropomorphic breast phantoms are critical for ex vivo validation of emerging elastographic technologies. This research develops heterogeneous breast phantoms for use in testing elastographic imaging modalities.

METHODS

Mechanical property estimation of eight different elastomers is performed to determine storage moduli (E') and damping ratios (ζ) using a dynamic mechanical analyzer. Dynamic compression testing was carried out isothermally at room temperature over a range of 4-50 Hz. Silicone compositions with physiologically realistic storage modulus were chosen for mimicking skin adipose, cancerous tumors, and pectoral muscles and 13 anthropomorphic breast phantoms were constructed for ex vivo trials of digital image elastotomography (DIET) breast cancer screening system. A simpler fabrication was used to assess the possibility of multiple tumor detection using magnetic resonance elastography (MRE).

RESULTS

Silicone materials with ranges of storage moduli (E') from 2 to 570 kPa and damping ratios (ζ) from 0.03 to 0.56 were identified. The resulting phantoms were tested in two different elastographic breast cancer diagnostic modalities. A significant contrast was successfully identified between healthy tissues and cancerous tumors both in MRE and DIET.

CONCLUSIONS

The phantoms presented promise aid to researchers in elastographic imaging modalities for breast cancer detection and provide a foundation for silicone based phantom materials for mimicking soft tissues of other human organs.

Development of oil-in-gelatin phantoms for viscoelasticity measurement in ultrasound shear wave elastography

Because tissues consist of solid and fluid materials, their mechanical properties should be characterized in terms of both elasticity and viscosity. Although the elastic properties of tissue-mimicking phantoms have been extensively studied and well characterized in commercially available phantoms, their viscous properties have not been fully investigated. In this article, a set of 14 tissue-mimicking phantoms with different concentrations of gelatin and castor oil were fabricated and characterized in terms of acoustic and viscoelastic properties. The results indicate that adding castor oil to gelatin phantoms decreases shear modulus, but increases shear wave dispersion. For 3% gelatin phantoms containing 0%, 10%, 20% and 40% oil, the measured shear moduli are 2.01 ± 0.26, 1.68 ± 0.25, 1.10 ± 0.22 and 0.88 ± 0.17 kPa, and the Voigt-model coupled shear viscosities are 0.60 ± 0.11, 0.89 ± 0.07, 1.05 ± 0.11 and 1.06 ± 0.13 Pa·s, respectively. The results also confirm that increasing the gelatin concentration increases shear modulus. For phantoms containing 3%, 4%, 5%, 6% and 7% gelatin, the measured shear moduli are 2.01 ± 0.26, 3.10 ± 0.34, 4.18 ± 0.84, 8.05 ± 1.00 and 10.24 ± 1.80 kPa at 0% oil and 1.10 ± 0.22, 1.97 ± 0.20, 3.13 ± 0.63, 4.60 ± 0.60 and 8.43 ± 1.39 kPa at 20% oil, respectively. The phantom recipe developed in this study can be used in validating ultrasound shear wave elastography techniques for soft tissues.

Development of MRI phantom equivalent to human tissues for 3.0-T MRI

PURPOSE

A 3.0-T MRI phantom (called the CAGN-3.0T phantom) having human-equivalent relaxation times and human-equivalent conductivity was developed.

METHODS

The ingredients of the phantom are carrageenan (as a gelatinizer), agarose (as a T2-relaxation modifier), GdCl3 (as a T1-relaxation modifier), NaCl (as a conductivity modifier), and NaN3 (as an antiseptic). Numerous samples with varying concentrations of agarose, GdCl3, and NaCl were prepared, and T1 and T2 values were measured using 3.0-T MRI.

RESULTS

The T1 values of the CAGN-3.0T phantom were unaffected by NaCl, while the T2 values were only slightly affected. Based on the measured data, empirical formulae were devised to express the relationships between the concentrations of agarose, GdCl3, and NaCl and the relaxation times. The formula for expressing the conductivity of the CAGN-3.0T phantom was obtained.

CONCLUSIONS

By adjustments to the concentrations of agarose, GdCl3, and NaCl, the relaxation times and conductivity of almost all types of human tissues can be simulated by CAGN-3.0T phantoms. The phantoms have T1 values of 395-2601 ms, T2 values of 29-334 ms, and conductivity of 0.27-1.26 S/m when concentrations of agarose, GdCl3, and NaCl are varied from 0 to 2.0 w/w%, 0 to 180 μmol/kg, and 0 to 0.7 w/w%, respectively. The CAGN-3.0T phantom has sufficient strength to replicate the torso without using reinforcing agents, and can be cut with a knife into any shape.

Tissue mimicking materials for the detection of prostate cancer using shear wave elastography: a validation study

PURPOSE

Quantification of stiffness changes may provide important diagnostic information and aid in the early detection of cancers. Shear wave elastography is an imaging technique that assesses tissue stiffness using acoustic radiation force as an alternate to manual palpation reported previously with quasistatic elastography. In this study, the elastic properties of tissue mimicking materials, including agar, polyacrylamide (PAA), and silicone, are evaluated with an objective to determine material characteristics which resemble normal and cancerous prostate tissue.

METHODS

Acoustic properties and stiffness of tissue mimicking phantoms were measured using compressional mechanical testing and shear wave elastography using supersonic shear imaging. The latter is based on the principles of shear waves generated using acoustic radiation force. The evaluation included tissue mimicking materials (TMMs) within the prostate at different positions and sizes that could mimic cancerous and normal prostate tissue. Patient data on normal and prostate cancer tissues quantified using biopsy histopathology were used to validate the findings. Pathologist reports on histopathology were blinded to mechanical testing and elastographic findings.

RESULTS

Young's modulus values of 86.2 ± 4.5 and 271.5 ± 25.7 kPa were obtained for PAA mixed with 2% Al(2)O(3) particles and silicone, respectively. Young's modulus of TMMs from mechanical compression testing showed a clear trend of increasing stiffness with an increasing percentage of agar. The silicone material had higher stiffness values when compared with PAA with Al(2)O(3). The mean Young's modulus value in cancerous tissue was 90.5 ± 4.5 kPa as compared to 93.8 ± 4.4 and 86.2 ± 4.5 kPa obtained with PAA with 2% Al(2)O(3) phantom at a depth of 52.4 and 36.6 mm, respectively.

CONCLUSIONS

PAA mixed with Al(2)O(3) provides the most suitable tissue mimicking material for prostate cancer tumor material, while agar could form the surrounding background to simulate normal prostate tissue.

Normal and shear strain imaging using 2D deformation tracking on beam steered linear array datasets

PURPOSE

Previous publications have reported on the use of one-dimensional cross-correlation analysis with beam-steered echo signals. However, this approach fails to accurately track displacements at larger depths (>4.5 cm) due to lower signal-to-noise. In this paper, the authors present the use of adaptive parallelogram shaped two-dimensional processing blocks for deformation tracking.

METHODS

Beam-steered datasets were acquired using a VFX 9L4 linear array transducer operated at a 6 MHz center frequency for steered angles from -15 to 15° in increments of 1°, on both uniformly elastic and single-inclusion tissue-mimicking phantoms. Echo signals were acquired to a depth of 65 mm with the focus set at 40 mm corresponding to the center of phantom. Estimated angular displacements along and perpendicular to the beam direction are used to compute axial and lateral displacement vectors using a least-squares approach. Normal and shear strain tensor component are then estimated based on these displacement vectors.

RESULTS

Their results demonstrate that parallelogram shaped two-dimensional deformation tracking significantly improves spatial resolution (factor of 7.79 along the beam direction), signal-to-noise (5 dB improvement), and contrast-to-noise (8-14 dB improvement) associated with strain imaging using beam steering on linear array transducers.

CONCLUSIONS

Parallelogram shaped two-dimensional deformation tracking is demonstrated in beam-steered radiofrequency data, enabling its use in the estimation of normal and shear strain components.

A novel breast software phantom for biomechanical modeling of elastography

PURPOSE

In developing breast imaging technologies, testing is done with phantoms. Physical phantoms are normally used but their size, shape, composition, and detail cannot be modified readily. These difficulties can be avoided by creating a software breast phantom. Researchers have created software breast phantoms using geometric and/or mathematical methods for applications like image fusion. The authors report a 3D software breast phantom that was built using a mechanical design tool, to investigate the biomechanics of elastography using finite element modeling (FEM). The authors propose this phantom as an intermediate assessment tool for elastography simulation; for use after testing with commonly used phantoms and before clinical testing. The authors design the phantom to be flexible in both, the breast geometry and biomechanical parameters, to make it a useful tool for elastography simulation.

METHODS

The authors develop the 3D software phantom using a mechanical design tool based on illustrations of normal breast anatomy. The software phantom does not use geometric primitives or imaging data. The authors discuss how to create this phantom and how to modify it. The authors demonstrate a typical elastography experiment of applying a static stress to the top surface of the breast just above a simulated tumor and calculate normal strains in 3D and in 2D with plane strain approximations with linear solvers. In particular, they investigate contrast transfer efficiency (CTE) by designing a parametric study based on location, shape, and stiffness of simulated tumors. The authors also compare their findings to a commonly used elastography phantom.

RESULTS

The 3D breast software phantom is flexible in shape, size, and location of tumors, glandular to fatty content, and the ductal structure. Residual modulus, maps, and profiles, served as a guide to optimize meshing of this geometrically nonlinear phantom for biomechanical modeling of elastography. At best, low residues (around 1-5 KPa) were found within the phantom while errors were elevated (around 10-30 KPa) at tumor and lobule boundaries. From our FEM analysis, the breast phantom generated a superior CTE in both 2D and in 3D over the block phantom. It also showed differences in CTE values and strain contrast for deep and shallow tumors and showed significant change in CTE when 3D modeling was used. These changes were not significant in the block phantom. Both phantoms, however, showed worsened CTE values for increased input tumor-background modulus contrast.

CONCLUSIONS

Block phantoms serve as a starting tool but a next level phantom, like the proposed breast phantom, will serve as a valuable intermediate for elastography simulation before clinical testing. Further, given the CTE metrics for the breast phantom are superior to the block phantom, and vary for tumor shape, location, and stiffness, these phantoms would enhance the study of elastography contrast. Further, the use of 2D phantoms with plane strain approximations overestimates the CTE value when compared to the true CTE achieved with 3D models. Thus, the use of 3D phantoms, like the breast phantom, with no approximations, will assist in more accurate estimation of modulus, especially valuable for 3D elastography systems.

A heterogeneous human tissue mimicking phantom for RF heating and MRI thermal monitoring verification

This paper describes a heterogeneous phantom that mimics a human thigh with a deep-seated tumor, for the purpose of studying the performance of radiofrequency (RF) heating equipment and non-invasive temperature monitoring with magnetic resonance imaging (MRI). The heterogeneous cylindrical phantom was constructed with an outer fat layer surrounding an inner core of phantom material mimicking muscle, tumor and marrow-filled bone. The component materials were formulated to have dielectric and thermal properties similar to human tissues. The dielectric properties of the tissue mimicking phantom materials were measured with a microwave vector network analyzer and impedance probe over the frequency range of 80-500 MHz and at temperatures of 24, 37 and 45 °C. The specific heat values of the component materials were measured using a differential scanning calorimeter over the temperature range of 15-55 °C. The thermal conductivity value was obtained from fitting the curves obtained from one-dimensional heat transfer measurement. The phantom was used to verify the operation of a cylindrical four-antenna annular phased array extremity applicator (140 MHz) by examining the proton resonance frequency shift (PRFS) thermal imaging patterns for various magnitude/phase settings (including settings to focus heating in tumors). For muscle and tumor materials, MRI was also used to measure T1/T2* values (1.5 T) and to obtain the slope of the PRFS phase change versus temperature change curve. The dielectric and thermal properties of the phantom materials were in close agreement to well-accepted published results for human tissues. The phantom was able to successfully demonstrate satisfactory operation of the tested heating equipment. The MRI-measured thermal distributions matched the expected patterns for various magnitude/phase settings of the applicator, allowing the phantom to be used as a quality assurance tool. Importantly, the material formulations for the various tissue types may be used to construct customized phantoms that are tailored for different anatomical sites.

Three-dimensional in silico breast phantoms for multimodal image simulations

Anatomic simulators have provided researchers with the realistic objects needed to develop and evaluate medical imaging approaches. Today we have new insights into the cellular biology of breast tissues that is driving many new targeted diagnostic and therapeutic approaches, including molecular imaging. We report on our initial efforts to build a scalable framework for the construction of realistic 3-D in silico breast phantoms (ISBP) capable of leveraging existing knowledge and yet adaptable to fully integrate future discoveries. The ISBP frames are developed with scalable anatomical shapes and morphologic features as adapted from a rich literature on this topic. Frames are populated with tissue subtypes essential for imaging and object contrast functions are assigned. These data can be resampled to match the intrinsics scales of various imaging modalities; we explore mammography, sonography and computed tomography. Initial comparisons between simulated and clinical images demonstrate reasonable agreement and provides guidance for future development of a more realistic ISBP. An end-to-end simulation of breast images is described to demonstrate techniques for including stochastic variability and deterministic physical principles on which image formation is based.

Shear wave dispersion measures liver steatosis

Crawling waves, which are interfering shear wave patterns, can be generated in liver tissue over a range of frequencies. Some important biomechanical properties of the liver can be determined by imaging the crawling waves using Doppler techniques and analyzing the patterns. We report that the dispersion of shear wave velocity and attenuation, that is, the frequency dependence of these parameters, are strongly correlated with the degree of steatosis in a mouse liver model, ex vivo. The results demonstrate the possibility of assessing liver steatosis using noninvasive imaging methods that are compatible with color Doppler scanners and, furthermore, suggest that liver steatosis can be separated from fibrosis by assessing the dispersion or frequency dependence of shear wave propagations.

Development of a human-tissue-like phantom for 3.0-T MRI

PURPOSE

A 3.0-T MRI phantom having human-tissue-equivalent relaxation times was developed.

METHODS

The ingredients of the phantom are carrageenan (for gelatinization), GdCl(3) (as a T(1)-relaxation modifier), agarose (as a T(2)-relaxation modifier), and NaN(3) (as an antiseptic agent). Numerous samples with varying concentrations of GdCl(3) and agarose were prepared, and T(1) and T(2) were measured using 3.0-T MRI.

RESULTS

Relaxation times of the phantom samples ranged from 395 to 2601 ms for T(1) values and 29 to 334 ms for T(2) values. Based on the measured results, empirical formulae were devised to express the relationships between the concentrations of relaxation modifiers and relaxation times.

CONCLUSIONS

Adjustment of GdCl(3) and agarose concentrations allows arbitrary setting of relaxation times, and the creation of a phantom that can mimic relaxation times of human-tissue. Carrageenan is considered the most suitable as a gelling agent for an MRI phantom, as it permits the relatively easy and inexpensive production of a large phantom such as for the human torso, and which can be easily shaped with a knife.

Analysis of shear strain imaging for classifying breast masses: finite element and phantom results

PURPOSE

Features extracted from axial-shear strain images of breast masses have been previously utilized to differentiate and classify benign from malignant breast masses. In this paper, we compare shear strain patterns exhibited by both the full-shear (axial and lateral component) versus only the axial-shear strain component for differentiating between bound masses (malignant) when compared to unbound masses (benign).

METHODS

We examine different breast mass characteristics such as mass shape, asymmetric location of masses, stiffness variations, and mass bonding characteristics to background tissue to assess their impact on shear strain patterns generated due to a uniaxial applied deformation. Two-dimensional finite element simulations of both circular and elliptical inclusions embedded within a uniform background were utilized. Different degrees of bonding were characterized using friction coefficient values ranging from 0.01 to 100 denoting loosely bound to firmly bound masses. Single-inclusion tissue-mimicking phantoms mimicking firmly bound and loosely bound ellipsoidal masses oriented at four different angles to the applied deformation were studied to corroborate the mass differentiation performance.

RESULTS

Our results indicate that the normalized axial-shear strain and full-shear strain area features are larger for bound when compared to unbound masses. A higher stiffness ratio or contrast between the inclusion and background also improves differentiation. Larger applied deformations reduce the discrimination performance for masses with friction coefficients lower than 0.4, due to increased mass slippage with applied deformations. Potential errors with the use of these features would occur for unbound inclusions at larger applied deformations and for asymmetric mass positions within the background normal tissue.

CONCLUSIONS

Finite element and tissue-mimicking phantom results demonstrate the feasibility of utilizing both the normalized axial-shear and full-shear strain area features to classify breast masses. Differentiation between bound or unbound masses was not affected by the mass size or shape for masses where the applied deformation is normal to the mass surface. Shear strain patterns vary significantly especially within unbound masses, when the mass surface is not normal to the applied deformation. Discrimination performance for unbound masses was improved by utilizing only the normalized shear strain area patterns located outside the mass as illustrated in this paper.

Review of ultrasound elastography quality control and training test phantoms

While the rapid development of ultrasound elastography techniques in recent decades has sparked its prompt implementation in the clinical setting adding new diagnostic information to conventional imaging techniques, questions still remain as to its full potential and efficacy in the hospital environment. A limited number of technical studies have objectively assessed the full capabilities of the different elastography approaches, perhaps due, in part, to the scarcity of suitable tissue-mimicking materials (TMMs) and appropriately designed phantoms available. Few commercially available elastography phantoms possess the necessary test target characteristics or mechanical properties observed clinically, or indeed reflect the lesion-to-background elasticity ratio encountered during clinical scanning. Thus, while some phantoms may prove useful, they may not fully challenge the capabilities of the different elastography techniques, proving limited when it comes to quality control (QC) and/or training purposes. Although a variety of elastography TMMs, such as agar and gelatine dispersions, co-polymer in oil and poly(vinyl) alcohol cryogel, have been developed for specific research purposes, such work is yet to produce appropriately designed phantoms to adequately challenge the variety of current commercially available elastography applications. Accordingly, there is a clear need for the further development of elastography TMMs and phantoms to keep pace with the rapid developments in elastography technology, to ensure that the performance of these new diagnostic approaches are validated, and for clinical training purposes.

Medical ultrasound: imaging of soft tissue strain and elasticity

After X-radiography, ultrasound is now the most common of all the medical imaging technologies. For millennia, manual palpation has been used to assist in diagnosis, but it is subjective and restricted to larger and more superficial structures. Following an introduction to the subject of elasticity, the elasticity of biological soft tissues is discussed and published data are presented. The basic physical principles of pulse-echo and Doppler ultrasonic techniques are explained. The history of ultrasonic imaging of soft tissue strain and elasticity is summarized, together with a brief critique of previously published reviews. The relevant techniques-low-frequency vibration, step, freehand and physiological displacement, and radiation force (displacement, impulse, shear wave and acoustic emission)-are described. Tissue-mimicking materials are indispensible for the assessment of these techniques and their characteristics are reported. Emerging clinical applications in breast disease, cardiology, dermatology, gastroenterology, gynaecology, minimally invasive surgery, musculoskeletal studies, radiotherapy, tissue engineering, urology and vascular disease are critically discussed. It is concluded that ultrasonic imaging of soft tissue strain and elasticity is now sufficiently well developed to have clinical utility. The potential for further research is examined and it is anticipated that the technology will become a powerful mainstream investigative tool.

Recent results in nonlinear strain and modulus imaging

We report a summary of recent developments and current status of our team's efforts to image and quantify in vivo nonlinear strain and tissue mechanical properties. Our work is guided by a focus on applications to cancer diagnosis and treatment using clinical ultrasound imaging and quasi-static tissue deformations. We review our recent developments in displacement estimation from ultrasound image sequences. We discuss cross correlation approaches, regularized optimization approaches, guided search methods, multiscale methods, and hybrid methods. Current implementations can return results of high accuracy in both axial and lateral directions at several frames per second.We compare several strain estimators. Again we see a benefit from a regularized optimization approach. We then discuss both direct and iterative methods to reconstruct tissue mechanical property distributions from measured strain and displacement fields. We review the formulation, discretization, and algorithmic considerations that come into play when attempting to infer linear and nonlinear elastic properties from strain and displacement measurements. Finally we illustrate our progress with example applications in breast disease diagnosis and tumor ablation monitoring. Our current status shows that we have demonstrated quantitative determination of nonlinear parameters in phantoms and in vivo, in the context of 2D models and data. We look forward to incorporating 3D data from 2D transducer arrays to noninvasively create calibrated 3D quantitative maps of nonlinear elastic properties of breast tissues in vivo.

Travelling wave expansion: a model fitting approach to the inverse problem of elasticity reconstruction

In this paper, a novel approach to the problem of elasticity reconstruction is introduced. In this approach, the solution of the wave equation is expanded as a sum of waves travelling in different directions sharing a common wave number. In particular, the solutions for the scalar and vector potentials which are related to the dilatational and shear components of the displacement respectively are expanded as sums of travelling waves. This solution is then used as a model and fitted to the measured displacements. The value of the shear wave number which yields the best fit is then used to find the elasticity at each spatial point. The main advantage of this method over direct inversion methods is that, instead of taking the derivatives of noisy measurement data, the derivatives are taken on the analytical model. This improves the results of the inversion. The dilatational and shear components of the displacement can also be computed as a byproduct of the method, without taking any derivatives. Experimental results show the effectiveness of this technique in magnetic resonance elastography. Comparisons are made with other state-of-the-art techniques.

Comprehensive analysis of the Cramer-Rao bounds for magnetic resonance temperature change measurement in fat-water voxels using multi-echo imaging

OBJECT

The aim of this paper is to characterize the noise propagation for MRI temperature change measurement with emphasis on finding the best echo time combinations that yield the lowest temperature noise.

MATERIALS AND METHODS

A Cramer-Rao lower-bound (CRLB) calculation was used to estimate the temperature noise for a model of the MR signal in fat-water voxels. The temperature noise CRLB was then used to find a set of echo times that gave the lowest temperature change noise for a range of fat-water frequency differences, temperature changes, fat/water signal ratios, and T2* values. CRLB estimates were verified by Monte Carlo simulation and in phantoms using images acquired in a 1.5 T magnet.

RESULTS

Results show that regions exist where the CRLB predicts minimal temperature variation as a function of the other variables. The results also indicate that the CRLB values calculated in this paper provide excellent guidance for predicting the variation of temperature measurements due to changes in the signal parameters. For three echo scans, the best noise characteristics are seen for TE values of 20.71, 23.71, and 26.71 ms. Results for five and seven echo scans are also presented in the text.

CONCLUSION

The results present a comprehensive analysis of the effects of different scan parameters on temperature noise, potentially benefiting the selection of scan parameters for clinical MRI thermometry.

Noninvasive temperature mapping with MRI using chemical shift water-fat separation

Tissues containing both water and lipids, e.g., breast, confound standard MR proton reference frequency-shift methods for mapping temperatures due to the lack of temperature-induced frequency shift in lipid protons. Generalized Dixon chemical shift-based water-fat separation methods, such as GE's iterative decomposition of water and fat with echo asymmetry and least-squares estimation method, can result in complex water and fat images. Once separated, the phase change over time of the water signal can be used to map temperature. Phase change of the lipid signal can be used to correct for non-temperature-dependent phase changes, such as amplitude of static field drift. In this work, an image acquisition and postprocessing method, called water and fat thermal MRI, is demonstrated in phantoms containing 30:70, 50:50, and 70:30 water-to-fat by volume. Noninvasive heating was applied in an Off1-On-Off2 pattern over 50 min, using a miniannular phased radiofrequency array. Temperature changes were referenced to the first image acquisition. Four fiber optic temperature probes were placed inside the phantoms for temperature comparison. Region of interest (ROI) temperature values colocated with the probes showed excellent agreement (global mean +/- standard deviation: -0.09 +/- 0.34 degrees C) despite significant amplitude of static field drift during the experiments.

A review of tissue substitutes for ultrasound imaging

The characterization and calibration of ultrasound imaging systems requires tissue-mimicking phantoms with known acoustic properties, dimensions and internal features. Tissue phantoms are available commercially for a range of medical applications. However, commercial phantoms may not be suitable in ultrasound system design or for evaluation of novel imaging techniques. It is often desirable to have the ability to tailor acoustic properties and phantom configurations for specific applications. A multitude of tissue-mimicking materials and phantoms are described in the literature that have been created using a variety of materials and preparation techniques and that have modeled a range of biological systems. This paper reviews ultrasound tissue-mimicking materials and phantom fabrication techniques that have been developed over the past four decades, and describes the benefits and disadvantages of the processes. Both soft tissue and hard tissue substitutes are explored.

Hyperthermia MRI temperature measurement: evaluation of measurement stabilisation strategies for extremity and breast tumours

PURPOSE

MR thermometry using the proton resonance frequency shift (PRFS) method has been used to measure temperature changes during clinical hyperthermia treatment. However, frequency drift of the MRI system can add large errors to the measured temperature change. These drifts can be measured and corrected using oil references placed around the treatment region. In this study, the number and position of four or more oil references were investigated to obtain a practical approach to correct frequency drift during PRFS thermometry in phantoms and in vivo.

MATERIALS AND METHODS

Experiments were performed in a 140 MHz four antenna mini-annular phased array (MAPA) heat applicator (for treatment of extremity tumours) and an applicator for heating of the breast, with symmetric and asymmetric positioning of the oil references, respectively. Temperature change PRFS images were obtained during an hour or more of measurement with no application of heat. Afterwards, errors in calculating temperature change due to system drift were quantified with and without various oil reference correction arrangements.

RESULTS

Results showed good temperature correction in phantoms and in a human leg, with average errors of 0.28 degrees C and 0.94 degrees C respectively. There was further improvement in the leg when using eight or more oil references, reducing the average error to 0.44 degrees C, while the phantoms showed no significant improvement.

CONCLUSIONS

These results indicate that oil reference correction performs well in vivo, and that eight references can improve the correction by up to 0.5 degrees C compared to four references.

A heterogeneous breast phantom for microwave breast imaging

Recently there has been significant attention given to imaging biological tissues using microwave radiation. In order to verify microwave imaging algorithms, realistic body models are needed to measure and simulate the penetration of microwave energy into the tissue and to reconstruct the image. We have created a phantom which has dielectric properties that are close to the properties of the real breast tissue. The phantom includes materials that accurately simulate the dielectric properties of skin, fat, gland and tumor tissues while providing good contrast of conductivity. The phantom is fabricated from materials that are widely available and is easy to make. In addition the elasticity of the materials enables the phantom to be shaped into two dimensional (2D) or three dimensional (3D) forms.

Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment

This study investigated the integration of the Calypso real-time tracking system, based on implanted ferromagnetic transponders and a detector array, into the current process for image-guided radiation treatment (IGRT) of prostate cancer at our institution. The current IGRT process includes magnetic resonance imaging (MRI) for prostate delineation, CT simulation for treatment planning, daily on-board kV and CBCT imaging for target alignment, and MRI/MRS for post-treatment assessment. This study assesses (1) magnetic-field-induced displacement and radio-frequency (RF)-induced heating of transponders during MRI at 1.5 T and 3 T, and (2) image artifacts caused by transponders and the detector array in phantom and patient cases with the different imaging systems. A tissue-equivalent phantom mimicking prostate tissue stiffness was constructed and implanted with three operational transponders prior to phantom solidification. The measurements show that the Calypso system is safe with all the imaging systems. Transponder position displacements due to the MR field are minimal (<1.0 mm) for both 1.5 T and 3 T MRI scanners, and the temperature variation due to MRI RF heating is <0.2 degrees C. The visibility of transponders and bony anatomy was not affected on the OBI kV and CT images. Image quality degradation caused by the detector antenna array is observed in the CBCT image. Image artifacts are most significant with the gradient echo sequence in the MR images, producing null signals surrounding the transponders with radii approximately 1.5 cm and length approximately 4 cm. Thus, Calypso transponders can preclude the use of MRI/MRS in post-treatment assessment. Modifications of the clinical flow are required to accommodate and minimize the substantial MRI artifacts induced by the Calypso transponders.