Integration of crawling waves in an ultrasound imaging system. Part 2: signal processing and applications

Modified Regularized Wavelength Average Velocity Estimator for normal excitation setup

Crawling Waves Sonoelastography (CWS) is an ultrasound elastography approach for the Shear Waves Speed (SWS) estimation. Several studies show promising results for tissue characterization. The algorithms used to calculate the SWS have been commonly implemented considering an opposing vibration sources to the side of the tissue of interest. However, implementing this mechanical setup has important limitations considering the geometry of the body. For that reason, a propagation from the top to the surface can be useful. Previous estimators such as Phase Derivative have been modified and tested in phantom studies, however, the presences of artifacts limited the performed of the SWS map. In this study, the Regularized Wavelength Average Velocity Estimator (R-WAVE) technique is modified and evaluated (RWm) to be used for normal propagation. The results of heterogeneous simulations and phantoms experiments showed consistent results with the literature (ie: Simulations Max Bias PDm 11.64 % • RWm 10.21 %, Max CNR PDm 37.82 dB • RWm 44.42 dB, Phantom Experiments Max Bias PDm 15.42 % • RWm 13.99 %, Max CNR PDm 24.14 dB • RWm 26.40 dB). The result of this study shows the potential of RWm to characterize the stiffness of the tissue as well as to differentiate tumors on in vivo applications.Clinical relevance This study presents a modification of the regularized shear wave speed estimator based on crawling waves sonoelastography approach for medical tissue analysis. This technique can be used to discriminate benignant from malignant tumors.

Shear Wave Speed estimator using Continuous Wavelet Transform for Crawling Wave Sonoelastography

Crawling Wave Sonoelastography (CWS) is an elastography ultrasound-based imaging approach that provides tissue stiffness information through the calculation of Shear Wave Speed (SWS). Many SWS estimators have been developed; however, they report important limitations such as the presence of artifacts, border effects or high computational cost. In addition, these techniques require a moving interference pattern which could be challenging for in vivo applications. In this study, a new estimator based on the Continuous Wavelet Transform (CWT) is proposed. This allows the generation of a SWS image for every sonoelasticity video frame. Testing was made with data acquired from experiments conducted on a gelatin phantom with a circular inclusion. It was excited with two vibration sources placed at both sides with frequencies ranging from 200 Hz to 360 Hz in steps of 20 Hz. Results show small variation of the SWS image across time. Additionally, images were compared with the Phase Derivative method (PD) and the Regularized Wavelength Average Velocity Estimator (R-WAVE). Similar SWS values were obtained for the three estimators within a certain region of interest in the inclusion (At 360 Hz, CWT: 5.01±0.2m/s, PD: 5.11±0.28m/s, R-WAVE: 4.51±0.62m/s) and in the background (At 360 Hz, CWT: 3.67±0.15m/s, PD: 3.69±0.23m/s, R-WAVE: 3.58±0.24m/s). CWT also presented the lowest coefficient of variation and the highest contrast-to-noise ratio for most frequencies, which allows better discrimination between regions.Clinical relevance-This study presents a new Shear Wave Speed estimator for Crawling Wave Sonoelastography, which can be useful to characterize soft tissue and detect lesions.

Real-Time Crawling Wave Sonoelastography for Human Muscle Characterization: Initial Results

Imaging of musculoskeletal tissue dynamics is currently an exploratory field with the goal of aiding rehabilitation and performance evaluation of pathological or asymptomatic patients. In this pilot study, initial elasticity assessments of the biceps brachii were conducted in a novel crawling wave sonoelastography (CWS) system implemented on a research ultrasound instrument with graphical processing unit capabilities, displaying quantitative elasticity values at 4 frames per second. The CWS system computes the tissue stiffness with the generation of an interference pattern from external vibrators, which can overcome depth limitations of imaging systems with internal excitation sources. Validation on gelatin-based phantoms reported low bias of elasticity values (4.7%) at low excitation frequencies. Preliminary results on in vivo muscle characterization are in accordance with average elasticity values for relaxed and contracted tissues found in the literature, as well as for a range of weight loads.

In vivo estimation of the Young's modulus in normal human dermis

Skin elastic properties change during a cutaneous disorder or in the aging process. Deep knowledge of skin layers helps monitoring and diagnosing structural changes. High frequency ultrasound (HF-US) has been recently introduced to diagnose and evaluate some dermatological disorders in the clinical practice. US elastography adds elasticity information of the analyzed tissue. In particular, harmonic elastography estimates the speed of shear waves produced by external vibration sources, in order to relate the shear wave speed to the Young's modulus. In the epidermis and dermis layers, shear waves are not generated; in contrast, surface acoustic waves (SAWs) exist as they propagate in the top of the tissue. This study uses crawling wave sonoelastography for the estimation of SAWs in human thigh dermis in vivo. Experiments were performed in ten volunteers in the range of 200 - 500 Hz. As other studies suggest, SAW speed needs to be compensated to reach shear wave speed, for calculating the Young's modulus. Thus, the SAW speed estimated was corrected when it propagates in solidUS gel interface. Specifically, the elasticity modulus found was $18.35 \pm 1.04$ KPa for a vibration frequency of 200 Hz. Results suggest that the elasticity modulus can be estimated in vivo using crawling wave HF-US for skin application and shows potential for future application in skin disorders.

Analysis of Transient Shear Wave in Lossy Media

The propagation of shear waves from impulsive forces is an important topic in elastography. Observations of shear wave propagation can be obtained with numerous clinical imaging systems. Parameter estimations of the shear wave speed in tissues, and more generally the viscoelastic parameters of tissues, are based on some underlying models of shear wave propagation. The models typically include specific choices of the spatial and temporal shape of the impulsive force and the elastic or viscoelastic properties of the medium. In this work, we extend the analytical treatment of 2-D shear wave propagation in a biomaterial. The approach applies integral theorems relevant to the solution of the generalized Helmholtz equation, and does not depend on a specific rheological model of the tissue's viscoelastic properties. Estimators of attenuation and shear wave speed are derived from the analytical solutions, and these are applied to an elastic phantom, a viscoelastic phantom and in vivo liver using a clinical ultrasound scanner. In these samples, estimated shear wave group velocities ranged from 1.7 m/s in the liver to 2.5 m/s in the viscoelastic phantom, and these are lower-bounded by independent measurements of phase velocity.

GPU-based Green's function simulations of shear waves generated by an applied acoustic radiation force in elastic and viscoelastic models

Shear wave calculations induced by an acoustic radiation force are very time-consuming on desktop computers, and high-performance graphics processing units (GPUs) achieve dramatic reductions in the computation time for these simulations. The acoustic radiation force is calculated using the fast near field method and the angular spectrum approach, and then the shear waves are calculated in parallel with Green's functions on a GPU. This combination enables rapid evaluation of shear waves for push beams with different spatial samplings and for apertures with different f/#. Relative to shear wave simulations that evaluate the same algorithm on an Intel i7 desktop computer, a high performance nVidia GPU reduces the time required for these calculations by a factor of 45 and 700 when applied to elastic and viscoelastic shear wave simulation models, respectively. These GPU-accelerated simulations also compared to measurements in different viscoelastic phantoms, and the results are similar. For parametric evaluations and for comparisons with measured shear wave data, shear wave simulations with the Green's function approach are ideally suited for high-performance GPUs.

Shear Wave Speed Estimation Using Reverberant Shear Wave Fields: Implementation and Feasibility Studies

Elastography is a modality that estimates tissue stiffness and, thus, provides useful information for clinical diagnosis. Attention has focused on the measurement of shear wave propagation; however, many methods assume shear wave propagation is unidirectional and aligned with the lateral imaging direction. Any deviations from the assumed propagation result in biased estimates of shear wave speed. To address these challenges, directional filters have been applied to isolate shear waves with different propagation directions. Recently, a new method was proposed for tissue stiffness estimation involving creation of a reverberant shear wave field propagating in all directions within the medium. These reverberant conditions lead to simple solutions, facile implementation and rapid viscoelasticity estimation of local tissue. In this work, this new approach based on reverberant shear waves was evaluated and compared with another well-known elastography technique using two calibrated elastic and viscoelastic phantoms. Additionally, the clinical feasibility of this technique was analyzed by assessing shear wave speed in human liver and breast tissues, in vivo. The results indicate that it is possible to estimate the viscoelastic properties in each scanned medium. Moreover, a better approach to estimation of shear wave speed was obtained when only the phase information was taken from the reverberant waves, which is equivalent to setting all magnitudes within the bandpass equal to unity: an idealization of a perfectly isotropic reverberant shear wave field.

Comparative study of shear wave-based elastography techniques in optical coherence tomography

We compare five optical coherence elastography techniques able to estimate the shear speed of waves generated by one and two sources of excitation. The first two techniques make use of one piezoelectric actuator in order to produce a continuous shear wave propagation or a tone-burst propagation (TBP) of 400 Hz over a gelatin tissue-mimicking phantom. The remaining techniques utilize a second actuator located on the opposite side of the region of interest in order to create three types of interference patterns: crawling waves, swept crawling waves, and standing waves, depending on the selection of the frequency difference between the two actuators. We evaluated accuracy, contrast to noise ratio, resolution, and acquisition time for each technique during experiments. Numerical simulations were also performed in order to support the experimental findings. Results suggest that in the presence of strong internal reflections, single source methods are more accurate and less variable when compared to the two-actuator methods. In particular, TBP reports the best performance with an accuracy error < 4.1 % . Finally, the TBP was tested in a fresh chicken tibialis anterior muscle with a localized thermally ablated lesion in order to evaluate its performance in biological tissue.

Guidelines for Finite-Element Modeling of Acoustic Radiation Force-Induced Shear Wave Propagation in Tissue-Mimicking Media

Ultrasound shear wave elastography is emerging as an important imaging modality for evaluating tissue material properties. In its practice, some systematic biases have been associated with ultrasound frequencies, focal depths and configuration, and transducer types (linear versus curvilinear), along with displacement estimation and shear wave speed estimation algorithms. Added to that, soft tissues are not purely elastic, so shear waves will travel at different speeds depending on their spectral content, which can be modulated by the acoustic radiation force (ARF) excitation focusing, duration, and the frequency-dependent stiffness of the tissue. To understand how these different acquisition and material property parameters may affect the measurements of shear wave velocity, the simulations of the propagation of shear waves generated by ARF excitations in viscoelastic media are a very important tool. This paper serves to provide an in-depth description of how these simulations are performed. The general scheme is broken into three components: 1) simulation of the 3-D ARF push beam; 2) applying that force distribution to a finite-element model; and 3) extraction of the motion data for post-processing. All three components will be described in detail and combined to create a simulation platform that is powerful for developing and testing algorithms for academic and industrial researchers involved in making quantitative shear-wave-based measurements of tissue material properties.

Shear Wave Speed Measurements Using Crawling Wave Sonoelastography and Single Tracking Location Shear Wave Elasticity Imaging for Tissue Characterization

Elastography provides tissue stiffness information that attempts to characterize the elastic properties of tissue. However, there is still limited literature comparing elastographic modalities for tissue characterization. This study focuses on two quantitative techniques using different vibration sources that have not been compared to date: crawling wave sonoelastography (CWS) and single tracking location shear wave elasticity imaging (STL-SWEI). To understand each technique's performance, shear wave speed (SWS) was measured in homogeneous phantoms and ex vivo beef liver tissue. Then, the contrast, contrast-to-noise ratio (CNR), and lateral resolution were measured in an inclusion and two-layer phantoms. The SWS values obtained with both modalities were validated with mechanical measurements (MM) which serve as ground truth. The SWS results for the three different homogeneous phantoms (10%, 13%, and 16% gelatin concentrations) and ex vivo beef liver tissue showed good agreement between CWS, STL-SWEI, and MM as a function of frequency. For all gelatin phantoms, the maximum accuracy errors were 2.52% and 2.35% using CWS and STL-SWEI, respectively. For the ex vivo beef liver, the maximum accuracy errors were 9.40% and 7.93% using CWS and STL-SWEI, respectively. For lateral resolution, contrast, and CNR, both techniques obtained comparable measurements for vibration frequencies less than 300 Hz (CWS) and distances between the push beams ( ∆x ) between 3 mm and 5.31 mm (STL-SWEI). The results obtained in this study agree over an SWS range of 1-6 m/s. They are expected to agree in perfectly linear, homogeneous, and isotropic materials, but the SWS overlap is not guaranteed in all materials because each of the three methods have unique features.

Temporal artifact minimization in sonoelastography through optimal selection of imaging parameters

Sonoelastography is an ultrasonic technique that uses Kasai's autocorrelation algorithms to generate qualitative images of tissue elasticity using external mechanical vibrations. In the absence of synchronization between the mechanical vibration device and the ultrasound system, the random initial phase and finite ensemble length of the data packets result in temporal artifacts in the sonoelastography frames and, consequently, in degraded image quality. In this work, the analytic derivation of an optimal selection of acquisition parameters (i.e., pulse repetition frequency, vibration frequency, and ensemble length) is developed in order to minimize these artifacts, thereby eliminating the need for complex device synchronization. The proposed rule was verified through experiments with heterogeneous phantoms, where the use of optimally selected parameters increased the average contrast-to-noise ratio (CNR) by more than 200% and reduced the CNR standard deviation by 400% when compared to the use of arbitrarily selected imaging parameters. Therefore, the results suggest that the rule for specific selection of acquisition parameters becomes an important tool for producing high quality sonoelastography images.

Crawling wave optical coherence elastography

Elastography is a technique that measures and maps the local elastic property of biological tissues. Aiming for detection of micron-scale inclusions, various optical elastography, especially optical coherence elastography (OCE), techniques have been investigated over the past decade. The challenges of current optical elastography methods include the decrease in elastographic resolution as compared with its parent imaging resolution, the detection sensitivity and accuracy, and the cost of the overall system. Here we report for the first time, we believe, on an elastography technique-crawling wave optical coherence elastography (CRW-OCE)-which significantly lowers the requirements on the imaging speed and opens the path to high-resolution and high-sensitivity OCE at relatively low cost. Methods of crawling wave excitation, data acquisition, and crawling wave tracking are presented.

Phase Aberration and Attenuation Effects on Acoustic Radiation Force-Based Shear Wave Generation

Elasticity is measured by shear wave elasticity imaging (SWEI) methods using acoustic radiation force to create the shear waves. Phase aberration and tissue attenuation can hamper the generation of shear waves for in vivo applications. In this study, the effects of phase aberration and attenuation in ultrasound focusing for creating shear waves were explored. This includes the effects of phase shifts and amplitude attenuation on shear wave characteristics such as shear wave amplitude, shear wave speed, shear wave center frequency, and bandwidth. Two samples of swine belly tissue were used to create phase aberration and attenuation experimentally. To explore the phase aberration and attenuation effects individually, tissue experiments were complemented with ultrasound beam simulations using fast object-oriented C++ ultrasound simulator (FOCUS) and shear wave simulations using finite-element-model (FEM) analysis. The ultrasound frequency used to generate shear waves was varied from 3.0 to 4.5 MHz. Results: The measured acoustic pressure and resulting shear wave amplitude decreased approximately 40%-90% with the introduction of the tissue samples. Acoustic intensity and shear wave displacement were correlated for both tissue samples, and the resulting Pearson's correlation coefficients were 0.99 and 0.97. Analysis of shear wave generation with tissue samples (phase aberration and attenuation case), measured phase screen, (only phase aberration case), and FOCUS/FEM model (only attenuation case) showed that tissue attenuation affected the shear wave generation more than tissue aberration. Decreasing the ultrasound frequency helped maintain a focused beam for creation of shear waves in the presence of both phase aberration and attenuation.

Characterization of transverse isotropy in compressed tissue-mimicking phantoms

Tissues such as skeletal muscle and kidneys have well-defined structure that affects the measurements of mechanical properties. As an approach to characterize the material properties of these tissues, different groups have assumed that they are transversely isotropic (TI) and measure the shear wave velocity as it varies with angle with respect to the structural architecture of the organ. To refine measurements in these organs, it is desirable to have tissue-mimicking phantoms that exhibit similar anisotropic characteristics. Some approaches involve embedding fibers into a material matrix. However, if a homogeneous solid is under compression due to a static stress, an acoustoelastic effect can manifest that makes the measured wave velocities change with the compression stress. We propose to exploit this characteristic to demonstrate that stressed tissue mimicking phantoms can be characterized as a TI material. We tested six phantoms made with different concentrations of gelatin and agar. Stress was applied by the weight of a water container centered on top of a plate on top of the phantom. A linear array transducer and a V-1 Verasonics system were used to induce and measure shear waves in the phantoms. The shear wave motion was measured using a compound plane wave imaging technique. Autocorrelation was applied to the received in-phase/quadrature data. The shear wave velocity, c, was estimated using a Radon transform method. The transducer was mounted on a rotating stage so measurements were made every 10° over a range of 0° to 360°, where the stress is applied along 0° to 180° direction. The shear moduli were estimated. A TI model was fit to the data and the fractional anisotropy was evaluated. This approach can be used to explore many configurations of transverse isotropy with the same phantom, simply by applying stress to the tissue-mimicking phantom.

Shear wave dispersion in lean versus steatotic rat livers

OBJECTIVES

The precise measurement of fat accumulation in the liver, or steatosis, is an important clinical goal. Our previous studies in phantoms and mouse livers support the hypothesis that, starting with a normal liver, increasing accumulations of microsteatosis and macrosteatosis will increase the lossy viscoelastic properties of shear waves in a medium. This increase results in an increased dispersion (or slope) of the shear wave speed in the steatotic livers.

METHODS

In this study, we moved to a larger animal model, lean versus obese rat livers ex vivo, and a higher-frequency imaging system to estimate the shear wave speed from crawling waves.

RESULTS

The results showed elevated dispersion in the obese rats and a separation of the lean versus obese liver parameters in a 2-dimensional parameter space of the dispersion (slope) and shear wave speed at a reference frequency of 150 Hz.

CONCLUSIONS

We have confirmed in 3 separate studies the validity of our dispersion hypothesis in animal models.

Characterization of transverse isotropy in compressed tissue-mimicking phantoms

Tissues such as skeletal muscle and kidneys have well-defined structure that affects the measurements of mechanical properties. As an approach to characterize the material properties of these tissues, different groups have assumed that they are transversely isotropic (TI) and measure the shear wave velocity as it varies with angle with respect to the structural architecture of the organ. To refine measurements in these organs, it is desirable to have tissue-mimicking phantoms that exhibit similar anisotropic characteristics. Some approaches involve embedding fibers into a material matrix. However, if a homogeneous solid is under compression due to a static stress, an acoustoelastic effect can manifest that makes the measured wave velocities change with the compression stress. We propose to exploit this characteristic to demonstrate that stressed tissue mimicking phantoms can be characterized as a TI material. We tested six phantoms made with different concentrations of gelatin and agar. Stress was applied by the weight of a water container centered on top of a plate on top of the phantom. A linear array transducer and a V-1 Verasonics system were used to induce and measure shear waves in the phantoms. The shear wave motion was measured using a compound plane wave imaging technique. Autocorrelation was applied to the received in-phase/quadrature data. The shear wave velocity, c, was estimated using a Radon transform method. The transducer was mounted on a rotating stage so measurements were made every 10° over a range of 0° to 360°, where the stress is applied along 0° to 180° direction. The shear moduli were estimated. A TI model was fit to the data and the fractional anisotropy was evaluated. This approach can be used to explore many configurations of transverse isotropy with the same phantom, simply by applying stress to the tissue-mimicking phantom.

Multi-source and multi-directional shear wave generation with intersecting steered ultrasound push beams

Elasticity imaging is becoming established as a means of assisting in diagnosis of certain diseases. Shear wave-based methods have been developed to perform elasticity measurements in soft tissue. Comb-push ultrasound shear elastography (CUSE) is one of these methods that apply acoustic radiation force to induce the shear wave in soft tissues. CUSE uses multiple ultrasound beams that are transmitted simultaneously to induce multiple shear wave sources into the tissue, with improved shear wave SNR and increased shear wave imaging frame rate. We propose a novel method that uses steered push beams (SPB) that can be applied for beam formation for shear wave generation. In CUSE beamforming, either unfocused or focused beams are used to create the propagating shear waves. In SPB methods we use unfocused beams that are steered at specific angles. The interaction of these steered beams causes shear waves to be generated in more of a random nature than in CUSE. The beams are typically steered over a range of 3 to 7° and can either be steered to the left (-θ) or right (+θ).We performed simulations of 100 configurations using Field II and found the best configurations based on spatial distribution of peaks in the resulting intensity field. The best candidates were ones with a higher number of the intensity peaks distributed over all depths in the simulated beamformed results. Then these optimal configurations were applied on a homogeneous phantom and two different phantoms with inclusions. In one of the inhomogeneous phantoms we studied two spherical inclusions with 10 and 20 mm diameters, and in the other phantom we studied cylindrical inclusions with diameters ranging from 2.53 to 16.67 mm. We compared these results with those obtained using conventional CUSE with unfocused and focused beams. The mean and standard deviation of the resulting shear wave speeds were used to evaluate the accuracy of the reconstructions by examining bias with nominal values for the phantoms as well as the contrast-to-noise ratio in the inclusion phantom results. In general the contrast-to-noise ratio (CNR) was higher and the bias was lower using the SPB method compared with the CUSE realizations except in the largest inclusions. In the cylindrical inclusion with 10.4 mm diameter, the CNR in CUSE methods ranged between 18.52 and 22.02 and the bias ranged between 5.50 and 11.12%, whereas for SPB methods provided CNR values between 23.07 and 48.90 and bias values between 3.78 and 9.22%. In a smaller cylindrical inclusion with diameter of 4.05 mm, CUSE methods gave CNR between 14.69 and 22.28 and bias ranging between 28.95 and 29.28%, whereas the SPB methods provided CNR values between 16.7 and 25.2 and bias values varying from 25.54 to 30.44%. The SPB method provides a flexible framework to produce shear wave sources that are widely distributed within the field-of-view for robust shear wave speed imaging.

Two-dimensional shear-wave elastography on conventional ultrasound scanners with time-aligned sequential tracking (TAST) and comb-push ultrasound shear elastography (CUSE)

Two-dimensional shear-wave elastography presents 2-D quantitative shear elasticity maps of tissue, which are clinically useful for both focal lesion detection and diffuse disease diagnosis. Realization of 2-D shear-wave elastography on conventional ultrasound scanners, however, is challenging because of the low tracking pulse-repetition-frequency (PRF) of these systems. Although some clinical and research platforms support software beamforming and plane-wave imaging with high PRF, the majority of current clinical ultrasound systems do not have the software beamforming capability, which presents a critical challenge for translating the 2-D shear-wave elastography technique from laboratory to clinical scanners. To address this challenge, this paper presents a time-aligned sequential tracking (TAST) method for shear-wave tracking on conventional ultrasound scanners. TAST takes advantage of the parallel beamforming capability of conventional systems and realizes high-PRF shear-wave tracking by sequentially firing tracking vectors and aligning shear wave data in the temporal direction. The comb-push ultrasound shear elastography (CUSE) technique was used to simultaneously produce multiple shear wave sources within the field-of-view (FOV) to enhance shear wave SNR and facilitate robust reconstructions of 2-D elasticity maps. TAST and CUSE were realized on a conventional ultrasound scanner. A phantom study showed that the shear-wave speed measurements from the conventional ultrasound scanner were in good agreement with the values measured from other 2-D shear wave imaging technologies. An inclusion phantom study showed that the conventional ultrasound scanner had comparable performance to a state-of-the-art shear-wave imaging system in terms of bias and precision in measuring different sized inclusions. Finally, in vivo case analysis of a breast with a malignant mass, and a liver from a healthy subject demonstrated the feasibility of using the conventional ultrasound scanner for in vivo 2-D shear-wave elastography. These promising results indicate that the proposed technique can enable the implementation of 2-D shear-wave elastography on conventional ultrasound scanners and potentially facilitate wider clinical applications with shear-wave elastography.

Shear wave speed and dispersion measurements using crawling wave chirps

This article demonstrates the measurement of shear wave speed and shear speed dispersion of biomaterials using a chirp signal that launches waves over a range of frequencies. A biomaterial is vibrated by two vibration sources that generate shear waves inside the medium, which is scanned by an ultrasound imaging system. Doppler processing of the acquired signal produces an image of the square of vibration amplitude that shows repetitive constructive and destructive interference patterns called "crawling waves." With a chirp vibration signal, successive Doppler frames are generated from different source frequencies. Collected frames generate a distinctive pattern which is used to calculate the shear speed and shear speed dispersion. A special reciprocal chirp is designed such that the equi-phase lines of a motion slice image are straight lines. Detailed analysis is provided to generate a closed-form solution for calculating the shear wave speed and the dispersion. Also several phantoms and an ex vivo human liver sample are scanned and the estimation results are presented.

Ultrasound elastography: the new frontier in direct measurement of muscle stiffness

The use of brightness-mode ultrasound and Doppler ultrasound in physical medicine and rehabilitation has increased dramatically. The continuing evolution of ultrasound technology has also produced ultrasound elastography, a cutting-edge technology that can directly measure the mechanical properties of tissue, including muscle stiffness. Its real-time and direct measurements of muscle stiffness can aid the diagnosis and rehabilitation of acute musculoskeletal injuries and chronic myofascial pain. It can also help monitor outcomes of interventions affecting muscle in neuromuscular and musculoskeletal diseases, and it can better inform the functional prognosis. This technology has implications for even broader use of ultrasound in physical medicine and rehabilitation practice, but more knowledge about its uses and limitations is essential to its appropriate clinical implementation. In this review, we describe different ultrasound elastography techniques for studying muscle stiffness, including strain elastography, acoustic radiation force impulse imaging, and shear-wave elastography. We discuss the basic principles of these techniques, including the strengths and limitations of their measurement capabilities. We review the current muscle research, discuss physiatric clinical applications of these techniques, and note directions for future research.

Elasticity estimates from images of crawling waves generated by miniature surface sources

We describe a surface-based approach to the generation of shear wave interference patterns, called crawling waves (CrW), within a medium and derive local estimates of biomechanical properties of tissue. In previous experiments, elongated bars operating as vibration sources were used to generate CrW propagation in samples. In the present study, however, a pair of miniature circular vibration sources was applied to the overlying skin to generate the CrW within the medium. The shape and position of the miniature sources make this configuration more applicable for in vivo implementation. A modified ultrasound imaging system is used to display the CrW propagation. A shear speed mapping algorithm is developed using a detailed analysis of the CrW. The proposed setup is applied to several biomaterials including a homogeneous phantom, an inhomogeneous phantom and an ex vivo human liver. The data are analyzed using the mapping algorithm to reveal the biomechanical properties of the biomaterials.

The Gaussian shear wave in a dispersive medium

In "imaging the biomechanical properties of tissues," a number of approaches analyze shear wave propagation initiated by a short radiation force push. Unfortunately, it has been experimentally observed that the displacement-versus-time curves for lossy tissues are rapidly damped and distorted in ways that can confound simple tracking approaches. This article addresses the propagation, decay and distortion of pulses in lossy and dispersive media, to derive closed-form analytic expressions for the propagating pulses. The theory identifies key terms that drive the distortion and broadening of the pulse. Furthermore, the approach taken is not dependent on any particular viscoelastic model of tissue, but instead takes a general first-order approach to dispersion. Examples with a Gaussian beam pattern and realistic dispersion parameters are given along with general guidelines for identifying the features of the distorting wave that are the most compact.

Mouse liver dispersion for the diagnosis of early-stage Fatty liver disease: a 70-sample study

The accumulation of fat droplets within the liver is an important marker of liver disease. This study assesses gradations of steatosis in mouse livers using crawling waves, which are interfering patterns of shear waves introduced into the liver by external sources. The crawling waves are detected by Doppler ultrasound imaging techniques, and these are analyzed to estimate the shear wave speed as a function of frequency between 200 and 360 Hz. In a study of 70 mice with progressive increases in steatosis from 0% to >60%, increases in steatosis are found to increase the dispersion, or frequency dependence, of shear wave speed. This finding confirms an earlier, smaller study and points to the potential of a scoring system for steatosis based on shear wave dispersion.

Comb-push ultrasound shear elastography (CUSE) with various ultrasound push beams

Comb-push ultrasound shear elastography (CUSE) has recently been shown to be a fast and accurate 2-D elasticity imaging technique that can provide a full field-of-view (FOV) shear wave speed map with only one rapid data acquisition. The initial version of CUSE was termed U-CUSE because unfocused ultrasound push beams were used. In this paper, we present two new versions of CUSE-focused CUSE (F-CUSE) and marching CUSE (M-CUSE), which use focused ultrasound push beams to improve acoustic radiation force penetration and produce stronger shear waves in deep tissues (e.g., kidney and liver). F-CUSE divides transducer elements into several subgroups which transmit multiple focused ultrasound beams simultaneously. M-CUSE uses more elements for each focused push beam and laterally marches the push beams. Both F-CUSE and M-CUSE can generate comb-shaped shear wave fields that have shear wave motion at each imaging pixel location so that a full FOV 2-D shear wave speed map can be reconstructed with only one data acquisition. Homogeneous phantom experiments showed that U-CUSE, F-CUSE, and M-CUSE can all produce smooth shear wave speed maps with accurate shear wave speed estimates. An inclusion phantom experiment showed that all CUSE methods could provide good contrast between the inclusion and background with sharp boundaries while F-CUSE and M-CUSE require shorter push durations to achieve shear wave speed maps with comparable SNR to U-CUSE. A more challenging inclusion phantom experiment with a very stiff and deep inclusion shows that better shear wave penetration could be gained by using F-CUSE and M-CUSE. Finally, a shallow inclusion experiment showed that good preservations of inclusion shapes could be achieved by both U-CUSE and F-CUSE in the near field. Safety measurements showed that all safety parameters are below FDA regulatory limits for all CUSE methods. These promising results suggest that, using various push beams, CUSE is capable of reconstructing a 2-D full FOV shear elasticity map using only one push-detection data acquisition in a wide range of depths for soft tissue elasticity imaging.

Acoustic waves in medical imaging and diagnostics

Up until about two decades ago acoustic imaging and ultrasound imaging were synonymous. The term ultrasonography, or its abbreviated version sonography, meant an imaging modality based on the use of ultrasonic compressional bulk waves. Beginning in the 1990s, there started to emerge numerous acoustic imaging modalities based on the use of a different mode of acoustic wave: shear waves. Imaging with these waves was shown to provide very useful and very different information about the biological tissue being examined. We discuss the physical basis for the differences between these two basic modes of acoustic waves used in medical imaging and analyze the advantages associated with shear acoustic imaging. A comprehensive analysis of the range of acoustic wavelengths, velocities and frequencies that have been used in different imaging applications is presented. We discuss the potential for future shear wave imaging applications.

Acoustic radiation force elasticity imaging in diagnostic ultrasound

The development of ultrasound-based elasticity imaging methods has been the focus of intense research activity since the mid-1990s. In characterizing the mechanical properties of soft tissues, these techniques image an entirely new subset of tissue properties that cannot be derived with conventional ultrasound techniques. Clinically, tissue elasticity is known to be associated with pathological condition and with the ability to image these features in vivo; elasticity imaging methods may prove to be invaluable tools for the diagnosis and/or monitoring of disease. This review focuses on ultrasound-based elasticity imaging methods that generate an acoustic radiation force to induce tissue displacements. These methods can be performed noninvasively during routine exams to provide either qualitative or quantitative metrics of tissue elasticity. A brief overview of soft tissue mechanics relevant to elasticity imaging is provided, including a derivation of acoustic radiation force, and an overview of the various acoustic radiation force elasticity imaging methods.

Comb-push ultrasound shear elastography (CUSE): a novel method for two-dimensional shear elasticity imaging of soft tissues

Fast and accurate tissue elasticity imaging is essential in studying dynamic tissue mechanical properties. Various ultrasound shear elasticity imaging techniques have been developed in the last two decades. However, to reconstruct a full field-of-view 2-D shear elasticity map, multiple data acquisitions are typically required. In this paper, a novel shear elasticity imaging technique, comb-push ultrasound shear elastography (CUSE), is introduced in which only one rapid data acquisition (less than 35 ms) is needed to reconstruct a full field-of-view 2-D shear wave speed map (40 × 38 mm). Multiple unfocused ultrasound beams arranged in a comb pattern (comb-push) are used to generate shear waves. A directional filter is then applied upon the shear wave field to extract the left-to-right (LR) and right-to-left (RL) propagating shear waves. Local shear wave speed is recovered using a time-of-flight method based on both LR and RL waves. Finally, a 2-D shear wave speed map is reconstructed by combining the LR and RL speed maps. Smooth and accurate shear wave speed maps are reconstructed using the proposed CUSE method in two calibrated homogeneous phantoms with different moduli. Inclusion phantom experiments demonstrate that CUSE is capable of providing good contrast (contrast-to-noise ratio ≥ 25 dB) between the inclusion and background without artifacts and is insensitive to inclusion positions. Safety measurements demonstrate that all regulated parameters of the ultrasound output level used in CUSE sequence are well below the FDA limits for diagnostic ultrasound.