Current time-domain methods for assessing tissue motion by analysis from reflected ultrasound echoes-a review

Machine-to-Machine Transfer Function in Deep Learning-Based Quantitative Ultrasound

A transfer function approach was recently demonstrated to mitigate data mismatches at the acquisition level for a single ultrasound scanner in deep learning (DL)-based quantitative ultrasound (QUS). As a natural progression, we further investigate the transfer function approach and introduce a machine-to-machine (M2M) transfer function, which possesses the ability to mitigate data mismatches at a machine level. This ability opens the door to unprecedented opportunities for reducing DL model development costs, enabling the combination of data from multiple sources or scanners, or facilitating the transfer of DL models between machines. We tested the proposed method utilizing a SonixOne machine and a Verasonics machine with an L9-4 array and an L11-5 array. We conducted two types of acquisitions to obtain calibration data: stable and free-hand, using two different calibration phantoms. Without the proposed method, the mean classification accuracy when applying a model on data acquired from one system to data acquired from another system was 50%, and the mean average area under the receiver operator characteristic (ROC) curve (AUC) was 0.405. With the proposed method, mean accuracy increased to 99%, and the AUC rose to the 0.999. Additional observations include the choice of the calibration phantom led to statistically significant changes in the performance of the proposed method. Moreover, robust implementation inspired by Wiener filtering provided an effective method for transferring the domain from one machine to another machine, and it can succeed using just a single calibration view. Lastly, the proposed method proved effective when a different transducer was used in the test machine.

Patellar Tendon Shear Wave Velocity Is Higher and has Different Regional Patterns in Elite Competitive Alpine Skiers than in Healthy Controls

Competitive alpine skiers are exposed to enormous forces acting on their bodies–particularly on the knee joint and hence the patellar tendon - during both the off-season preparation and in-season competition phases. However, factors influencing patellar tendon adaptation and regional pattern differences between alpine skiers and healthy controls are not yet fully understood, but are essential for deriving effective screening approaches and preventative countermeasures. Thirty elite competitive alpine skiers, all members of the Swiss Alpine Ski Team, and 38 healthy age-matched controls were recruited. A set of two-dimensional shear wave elastography measurements of the PT was acquired and projected into three-dimensional space yielding a volumetric representation of the shear wave velocity profile of the patellar tendon. Multivariate linear models served to quantify differences between the two cohorts and effects of other confounding variables with respect to regional shear wave velocity. A significant (p < 0.001) intergroup difference was found between skiers (mean ± SD = 10.4 ± 1.32 m/s) and controls (mean ± SD = 8.9 ± 1.59 m/s). A significant sex difference was found within skiers (p = 0.024), but no such difference was found in the control group (p = 0.842). Regional SWV pattern alterations between skiers and controls were found for the distal region when compared to the mid-portion (p = 0.023). Competitive alpine skiers exhibit higher SWV in all PT regions than healthy controls, potentially caused by long-term adaptations to heavy tendon loading. The presence of sex-specific differences in PT SWV in skiers but not in controls indicates that sex effects have load-dependent dimensions. Alterations in regional SWV patterns between skiers and controls suggest that patellar tendon adaptation is region specific. In addition to the implementation of 3D SWE, deeper insights into long-term tendon adaptation and normative values for the purpose of preventative screening are provided.

Boosting transducer matrix sensitivity for 3D large field ultrasound localization microscopy using a multi-lens diffracting layer: a simulation study

Mapping blood microflows of the whole brain is crucial for early diagnosis of cerebral diseases. Ultrasound localization microscopy (ULM) was recently applied to map and quantify blood microflows in 2D in the brain of adult patients down to the micron scale. Whole brain 3D clinical ULM remains challenging due to the transcranial energy loss which significantly reduces the imaging sensitivity. Large aperture probes with a large surface can increase both resolution and sensitivity. However, a large active surface implies thousands of acoustic elements, with limited clinical translation. In this study, we investigate via simulations a new high-sensitive 3D imaging approach based on large diverging elements, combined with an adapted beamforming with corrected delay laws, to increase sensitivity. First, pressure fields from single elements with different sizes and shapes were simulated. High directivity was measured for curved element while maintaining high transmit pressure. Matrix arrays of 256 elements with a dimension of 10 × 10 cm with small (λ/2), large (4λ), and curved elements (4λ) were compared through point spread functions analysis. A large synthetic microvessel phantom filled with 100 microbubbles per frame was imaged using the matrix arrays in a transcranial configuration. 93% of the bubbles were detected with the proposed approach demonstrating that the multi-lens diffracting layer has a strong potential to enable 3D ULM over a large field of view through the bones.

Emerging Technology: Ultrasound Vector Flow Imaging—A Novel Approach to Arterial Hemodynamic Quantification

Accurate, reliable, and easily obtainable quantification of peripheral arterial hemodynamic states has long been a holy grail of vascular ultrasound. While conventional Doppler modalities have been relied upon for decades to provide velocity, directionality, and flow volume data for integration into patient management schema, they carry limitations in accurately and reproducibly quantifying complex arterial hemodynamic patterns. Advances in ultrasound imaging architecture, such as virtual beamforming, integration of “big data” capabilities, and the use of enhanced digital signal processing methods have opened the door for a novel approach to arterial hemodynamic mapping and quantification—ultrasound vector flow imaging (VFI). This article presents an overview of the technological underpinnings of VFI, compares it with conventional pulsed wave and color Doppler methods, and describes the potential clinical benefits of this emerging vascular ultrasound modality.

In Vivo Comparison of Multiline Transmission and Diverging Wave Imaging for High-Frame-Rate Speckle-Tracking Echocardiography

High-frame-rate (HFR) speckle-tracking echocardiography (STE) assesses myocardial function by quantifying motion and deformation at high temporal resolution. Among the proposed HFR techniques, multiline transmission (MLT) and diverging wave (DW) imaging have been used in this context both being characterized by specific advantages and disadvantages. Therefore, in this article, we directly contrast both approaches in an in vivo setting while operating at the same frame rate (FR). First, images were recorded at baseline (resting condition) from healthy volunteers and patients. Next, additional acquisitions during stress echocardiography were performed on volunteers. Each scan was contoured and processed by a previously proposed 2-D HFR STE algorithm based on cross correlation. Then, strain curves and their end-systolic (ES) values were extracted for all myocardial segments for further statistical analysis. The baseline acquisitions did not reveal differences in estimated strain between the acquisition modes ( ); myocardial segments ( ); or an interaction between imaging mode and depth ( ). Similarly, during stress testing, no difference ( p = 0.7 ) was observed for the two scan sequences, stress levels or an interaction sequence-stress level ( p = 0.94 ). Overall, our findings show that MLT and DW compoundings give comparable HFR STE strain values and that the choice for using one method or the other may thus rather be based on other factors, for example, system requirements or computational cost.

Three-Dimensional Mapping of Shear Wave Velocity in Human Tendon: A Proof of Concept Study

Ultrasound-based shear wave elastography (SWE) provides the means to quantify tissue mechanical properties in vivo and has proven valuable in detecting degenerative processes in tendons. Its current mode of use is for two-dimensional rendering measurements, which are highly position-dependent. We therefore propose an approach to create a volumetric reconstruction of the mechano-acoustic properties of a structure of interest based on optically tracking the ultrasound probe during free-hand measurement sweeps. In the current work, we aimed (1) to assess the technical feasibility of the three-dimensional mapping of unidirectional shear wave velocity (SWV), (2) to evaluate the possible artefacts associated with hand-held image acquisition, (3) to investigate the reproducibility of the proposed technique, and (4) to study the potential of this method in detecting local adaptations in a longitudinal study setting. Operative and technical feasibility as well as potential artefacts associated with hand-held image acquisition were studied on a synthetic phantom containing discrete targets of known mechanical properties. Measurement reproducibility was assessed based on inter-day and inter-reader scans of the patellar, Achilles, and supraspinatus tendon of ten healthy volunteers and was compared to traditional two-dimensional image acquisition. The potential of this method in detecting local adaptations was studied by testing the effect of short-term voluntary isometric loading history on SWV along the tendon long axis. The suggested approach was technically feasible and reproducible, with a moderate to very good reliability and a standard error of measurement in the range of 0.300-0.591 m/s for the three assessed tendons at the two test-retest modalities. We found a consistent variation in SWV along the longitudinal axis of each tendon, and isometric loading resulted in regional increases in SWV in the patellar and Achilles tendons. The proposed method outperforms traditional two-dimensional measurement with regards to reproducibility and may prove valuable in the objective assessment of pathological tendon changes.

Fast Randomized Singular Value Decomposition-Based Clutter Filtering for Shear Wave Imaging

The mechanical properties of soft tissues can be quantitatively characterized through the estimation of shear wave velocity (SWV) using various motion estimation methods, such as the commonly used block matching (BM) methods. However, such methods suffer from slow computational speed and many tunable parameters. In order to solve these problems, Butterworth filter-based clutter filter wave imaging (BW-CFWI) is recently proposed to detect the mechanical wave propagation by highlighting the tissue velocity induced by mechanical wave, without using any motion estimation methods. In this study, in order to improve the SWV estimation performance of the clutter filter wave imaging (CFWI) method, we propose singular value decomposition (SVD)-based clutter filter for CFWI (SVD-CFWI) and further accelerate it using a randomized SVD (rSVD)-based clutter filter (rSVD-CFWI). Homogeneous phantoms with different Young's moduli are used to investigate the influences of the cutoff order of singular value and iteration time on the performance of SWV estimation. An elasticity phantom with stepped cylindrical inclusions is tested for comparison of rSVD-CFWI, SVD-CFWI, BW-CFWI, and normalized cross-correlation (NCC)-based BM (NCC-BM). The performances of the proposed methods are also evaluated on data acquired from the bicipital muscle in vivo. The results of phantom experiments show that rSVD-CFWI and SVD-CFWI reconstruct SWV maps with improved shape of the inclusions. For the softest inclusion with a diameter of 10.40 mm, the contrast-to-noise ratios (CNRs) between the inclusions and background obtained with rSVD-CFWI (3.78 dB) and SVD-CFWI (3.71 dB) are higher than those obtained with BW-CFWI (0.55 dB) and NCC-BM (0.70 dB). For the stiffest inclusion with a diameter of 10.40 mm, higher CNRs are also achieved by rSVD-CFWI (5.68 dB) and SVD-CFWI (5.07 dB) than by BW-CFWI (2.92 dB) and NCC-BM (2.36 dB). In the in-vivo experiments, more homogeneous SWV maps and smaller standard deviations of SWVs are obtained with rSVD-CFWI and SVD-CFWI than with BW-CFWI and NCC-BM. Besides, RSVD-CFWI has lower computational complexity than SVD-CFWI and NCC-BM and has lower memory space requirement than SVD-CFWI. The computational speed of rSVD-CFWI is comparable to that of BW-CFWI and over 10 times higher than that of SVD-CFWI. Therefore, RSVD-CFWI is demonstrated to be a competitive tool for fast shear wave imaging.

Carotid Wall Longitudinal Motion in Ultrasound Imaging: An Expert Consensus Review

Motion extracted from the carotid artery wall provides unique information for vascular health evaluation. Carotid artery longitudinal wall motion corresponds to the multiphasic arterial wall excursion in the direction parallel to blood flow during the cardiac cycle. While this motion phenomenon has been well characterized, there is a general lack of awareness regarding its implications for vascular health assessment or even basic vascular physiology. In the last decade, novel estimation strategies and clinical investigations have greatly advanced our understanding of the bi-axial behavior of the carotid artery, necessitating an up-to-date review to summarize and classify the published literature in collaboration with technical and clinical experts in the field. Within this review, the state-of-the-art methodologies for carotid wall motion estimation are described, and the observed relationships between longitudinal motion-derived indices and vascular health are reported. The vast number of studies describing the longitudinal motion pattern in plaque-free arteries, with its putative application to cardiovascular disease prediction, point to the need for characterizing the added value and applicability of longitudinal motion beyond established biomarkers. To this aim, the main purpose of this review was to provide a strong base of theoretical knowledge, together with a curated set of practical guidelines and recommendations for longitudinal motion estimation in patients, to foster future discoveries in the field, toward the integration of longitudinal motion in basic science as well as clinical practice.

An Angle-Independent Cross-Sectional Doppler Method for Flow Estimation in the Common Carotid Artery

The Doppler ultrasound is the most common technique for noninvasive quantification of blood flow, which, in turn, is of major clinical importance for the assessment of the cardiovascular condition. In this article, a method is proposed in which the vessel is imaged in the short axis, which has the advantage of capturing the whole flow profile while measuring the vessel area simultaneously. This view is easier to obtain than the longitudinal image that is currently used in flow velocity estimation, reducing operator dependence. However, the Doppler angle in cross-sectional images is unknown since the vessel wall can no longer be used to estimate the flow direction. The proposed method to estimate the Doppler angle in these images is based on the elliptical intersection between a cylindrical vessel and the ultrasound plane. The parameters of this ellipse (major axis, minor axis, and rotation) are used to estimate the Doppler angle by solving a least-squares problem. Theoretical feasibility was shown in a geometrical model, after which the Doppler angle was estimated in simulated ultrasound images generated in Field II, yielding a mean error within 4°. In vitro, across 15 short-axis measurements with a wide variety of Doppler angles, errors in the flow estimates were below 10%, and in vivo, the average velocities in systole obtained from longitudinal ( v=69.1 cm/s) and cross-sectional ( v=66.5 cm/s) acquisitions were in agreement. Further research is required to validate these results on a larger population.

Neural-network-based Motion Tracking for Breast Ultrasound Strain Elastography: An Initial Assessment of Performance and Feasibility

Accurate tracking of tissue motion is critically important for several ultrasound elastography methods. In this study, we investigate the feasibility of using three published convolution neural network (CNN) models built for optical flow (hereafter referred to as CNN-based tracking) by the computer vision community for breast ultrasound strain elastography. Elastographic datasets produced by finite element and ultrasound simulations were used to retrain three published CNN models: FlowNet-CSS, PWC-Net, and LiteFlowNet. After retraining, the three improved CNN models were evaluated using computer-simulated and tissue-mimicking phantoms, and in vivo breast ultrasound data. CNN-based tracking results were compared with two published two-dimensional (2D) speckle tracking methods: coupled tracking and GLobal Ultrasound Elastography (GLUE) methods. Our preliminary data showed that, based on the Wilcoxon rank-sum tests, the improvements due to retraining were statistically significant (p < 0.05) for all three CNN models. We also found that the PWC-Net model was the best neural network model for data investigated, and its overall performance was on par with the coupled tracking method. CNR values estimated from in vivo axial and lateral strain elastograms showed that the GLUE algorithm outperformed both the retrained PWC-Net model and the coupled tracking method, though the GLUE algorithm exhibited some biases. The PWC-Net model was also able to achieve approximately 45 frames/second for 2D speckle tracking data investigated.

Comparison Between Multiline Transmission and Diverging Wave Imaging: Assessment of Image Quality and Motion Estimation Accuracy

High frame rate imaging is particularly important in echocardiography for better assessment of the cardiac function. Several studies showed that diverging wave imaging (DWI) and multiline transmission (MLT) are promising methods for achieving a high temporal resolution. The aim of this study was to compare MLT and compounded motion compensation (MoCo) DWI for the same transmitted power, same frame rates [image quality and speckle tracking echocardiography (STE) assessment], and same packet size [tissue Doppler imaging (TDI) assessment]. Our results on static images showed that MLT outperforms DW in terms of resolution (by 30% on average). However, in terms of contrast, MLT outperforms DW only for the depth of 11 cm (by 40% on average), the result being reversed at a depth of 4 cm (by 27% on average). In vitro results on a spinning phantom at nine different velocities showed that similar STE axial errors (up to 2.3% difference in median errors and up to 2.1% difference in the interquartile ranges) are obtained with both ultrafast methods. On the other hand, the median lateral STE estimates were up to 13% more accurate with DW than with MLT. On the contrary, the accuracy of TDI was only up to ~3% better with MLT, but the achievable DW Doppler frame rate was up to 20 times higher. However, our overall results showed that the choice of one method relative to the other is therefore dependent on the application. More precisely, in terms of image quality, DW is more suitable for imaging structures at low depths, while MLT can provide an improved image quality at the focal point that can be placed at higher depths. In terms of motion estimation, DW is more suitable for color Doppler-related applications, while MLT could be used to estimate velocities along selected lines of the image.

Specific Ultrasound Data Acquisition for Tissue Motion and Strain Estimation: Initial Results

Ultrasound applications such as elastography can benefit from 3-D data acquisition and processing. In this article, we describe a specific ultrasound probe, designed to acquire series of three adjacent imaging planes over time. This data acquisition makes it possible to consider the out-of-plane motion that can occur at the central plane during medium scanning, and is proposed with the aim of improving the results of strain imaging. In this first study, experiments were conducted on phantoms, and controlled axial and elevational displacements were applied to the probe using a motorized system. Radiofrequency ultrasound data were acquired at a 40-MHz sampling frequency with an Ultrasonix ultrasound scanner, and processed using a 3-D motion estimation method. For each of the 2-D regions of interest of the central plane in pre-compression data, a 3-D search was run to determine its corresponding version in post-compression data, with this search taking into account the region-of-interest deformation model chosen. The results obtained with the proposed ultrasound data acquisition and strain estimation were compared with results from a classic approach and illustrate the improvement produced by considering the medium's local displacements in elevation, with notably an increase in the mean correlation coefficients achieved.

A combination of parabolic and grid slope interpolation for 2D tissue displacement estimations

Parabolic sub-sample interpolation for 2D block-matching motion estimation is computationally efficient. However, it is well known that the parabolic interpolation gives a biased motion estimate for displacements greater than |y.2| samples (y = 0, 1, …). Grid slope sub-sample interpolation is less biased, but it shows large variability for displacements close to y.0. We therefore propose to combine these sub-sample methods into one method (GS15PI) using a threshold to determine when to use which method. The proposed method was evaluated on simulated, phantom, and in vivo ultrasound cine loops and was compared to three sub-sample interpolation methods. On average, GS15PI reduced the absolute sub-sample estimation errors in the simulated and phantom cine loops by 14, 8, and 24% compared to sub-sample interpolation of the image, parabolic sub-sample interpolation, and grid slope sub-sample interpolation, respectively. The limited in vivo evaluation of estimations of the longitudinal movement of the common carotid artery using parabolic and grid slope sub-sample interpolation and GS15PI resulted in coefficient of variation (CV) values of 6.9, 7.5, and 6.8%, respectively. The proposed method is computationally efficient and has low bias and variance. The method is another step toward a fast and reliable method for clinical investigations of longitudinal movement of the arterial wall.

A GPU-Accelerated 3-D Coupled Subsample Estimation Algorithm for Volumetric Breast Strain Elastography

Our primary objective of this paper was to extend a previously published 2-D coupled subsample tracking algorithm for 3-D speckle tracking in the framework of ultrasound breast strain elastography. In order to overcome heavy computational cost, we investigated the use of a graphic processing unit (GPU) to accelerate the 3-D coupled subsample speckle tracking method. The performance of the proposed GPU implementation was tested using a tissue-mimicking phantom and in vivo breast ultrasound data. The performance of this 3-D subsample tracking algorithm was compared with the conventional 3-D quadratic subsample estimation algorithm. On the basis of these evaluations, we concluded that the GPU implementation of this 3-D subsample estimation algorithm can provide high-quality strain data (i.e., high correlation between the predeformation and the motion-compensated postdeformation radio frequency echo data and high contrast-to-noise ratio strain images), as compared with the conventional 3-D quadratic subsample algorithm. Using the GPU implementation of the 3-D speckle tracking algorithm, volumetric strain data can be achieved relatively fast (approximately 20 s per volume [2.5 cm ×2.5 cm ×2.5 cm]).

3D Myocardial Elastography In Vivo

Strain evaluation is of major interest in clinical cardiology as it can quantify the cardiac function. Myocardial elastography, a radio-frequency (RF)-based cross-correlation method, has been developed to evaluate the local strain distribution in the heart in vivo. However, inhomogeneities such as RF ablation lesions or infarction require a three-dimensional approach to be measured accurately. In addition, acquisitions at high volume rate are essential to evaluate the cardiac strain in three dimensions. Conventional focused transmit schemes using 2D matrix arrays, trade off sufficient volume rate for beam density or sector size to image rapid moving structure such as the heart, which lowers accuracy and precision in the strain estimation. In this study, we developed 3D myocardial elastography at high volume rates using diverging wave transmits to evaluate the local axial strain distribution in three dimensions in three open-chest canines before and after radio-frequency ablation. Acquisitions were performed with a 2.5 MHz 2D matrix array fully programmable used to emit 2000 diverging waves at 2000 volumes/s. Incremental displacements and strains enabled the visualization of rapid events during the QRS complex along with the different phases of the cardiac cycle in entire volumes. Cumulative displacement and strain volumes depict high contrast between non-ablated and ablated myocardium at the lesion location, mapping the tissue coagulation. 3D myocardial strain elastography could thus become an important technique to measure the regional strain distribution in three dimensions in humans.

Ultrasound Vector Flow Imaging-Part I: Sequential Systems

This paper gives a review of the most important methods for blood velocity vector flow imaging (VFI) for conventional sequential data acquisition. This includes multibeam methods, speckle tracking, transverse oscillation, color flow mapping derived VFI, directional beamforming, and variants of these. The review covers both 2-D and 3-D velocity estimation and gives a historical perspective on the development along with a summary of various vector flow visualization algorithms. The current state of the art is explained along with an overview of clinical studies conducted and methods for presenting and using VFI. A number of examples of VFI images are presented, and the current limitations and potential solutions are discussed.

Systematic Performance Evaluation of a Cross-Correlation-Based Ultrasound Strain Imaging Method

Estimation of tissue motion in the lateral direction remains a major challenge in 2-D ultrasound strain imaging (USI). Although various methodologies have been proposed to improve the accuracy of estimation of in-plane displacements and strains, the fundamental limitations of 2-D USI and how to choose optimal algorithmic parameters in various tissue deformation paradigms to retrieve the full strain tensor of acceptable accuracy are scattered throughout the literature. Thus, this study attempts to provide a systematic investigation of a 2-D cross-correlation-based USI method in a theoretical framework. Our previously developed cross-correlation-based USI method was revisited, and additional estimation strategies were incorporated to improve in-plane displacement and strain estimation. The performance of the presented method using different matching kernel sizes (axial: from 1λ to 14λ, where λ = wavelength; lateral: from 1 to 13 pitches) and two data formats (radiofrequency and envelope) in various kinematic scenarios (normal, shear or hybrid deformation) was investigated using Field II simulations, in which coherent plane wave compounding with 64 steered angles was realized. For radiofrequency-based USI, smaller axial and larger lateral kernel sizes were preferred in scenarios with normal strains, whereas larger kernel sizes along the shearing direction and smaller ones orthogonal to the shearing direction were more suitable in scenarios with shear strains. For envelope-based USI, in contrast, the kernel size requirement was relatively relaxed. A compromise between optimal kernel sizes and estimation accuracy of various strain components was required in complex kinematic scenarios. These practical strategies for accurate motion estimation using 2-D cross-correlation-based USI were further tested in a tissue-mimicking phantom under quasi-static compression and in a preliminary in vivo examination of a normal human median nerve at the wrist during active finger motion.

Evaluation of an Extended Autocorrelation Phase Estimator for Ultrasonic Velocity Profiles Using Nondestructive Testing Systems

In this paper the extended autocorrelation velocity estimator is evaluated and compared using a nondestructive ultrasonic device. For this purpose, three velocity estimators are evaluated and compared. The autocorrelation method (ACM) is the most used and well established in current ultrasonic velocity profiler technology, however, the technique suffers with phase aliasing (also known as the Nyquist limit) at higher velocities. The cross-correlation method (CCM) is also well known and does not suffer with phase aliasing as it relies on time shift measurements between emissions. The problem of this method is the large computational burden due to several required mathematical operations. Recently, an extended autocorrelation method (EAM) which combines both ACM and CCM was developed. The technique is not well known within the fluid engineering community, but it can measure velocities beyond the Nyquist limit without the ACM phase aliasing issues and with a lower computational cost than CCM. In this work, all three velocity estimation methods are used to measure a uniform flow of the liquid inside a controlled rotating cylinder. The root-mean-square deviation variation coefficient (CVRMSD) of the velocity estimate and the reference cylinder velocity was used to evaluate the three different methods. Results show that EAM correctly measures velocities below the Nyquist limit with less than 2% CVRMSD. Velocities beyond the Nyquist limit are only measured well by EAM and CCM, with the advantage of the former of being computationally 15 times faster. Furthermore, the maximum value of measurable velocity is also investigated considering the number of times the velocity surpasses the Nyquist limit. The combination of number of pulses and number of samples, which highly affects the results, are also studied in this work. Velocities up to six times the Nyquist limit could be measurable with CCM and EAM using a set of parameters as suggested in this work. The results validate the use of the NDT tool to measure velocities even beyond Nyquist limit by using EAM.

Review of ultrasound image guidance in external beam radiotherapy part II: intra-fraction motion management and novel applications

Imaging has become an essential tool in modern radiotherapy (RT), being used to plan dose delivery prior to treatment and verify target position before and during treatment. Ultrasound (US) imaging is cost-effective in providing excellent contrast at high resolution for depicting soft tissue targets apart from those shielded by the lungs or cranium. As a result, it is increasingly used in RT setup verification for the measurement of inter-fraction motion, the subject of Part I of this review (Fontanarosa et al 2015 Phys. Med. Biol. 60 R77-114). The combination of rapid imaging and zero ionising radiation dose makes US highly suitable for estimating intra-fraction motion. The current paper (Part II of the review) covers this topic. The basic technology for US motion estimation, and its current clinical application to the prostate, is described here, along with recent developments in robust motion-estimation algorithms, and three dimensional (3D) imaging. Together, these are likely to drive an increase in the number of future clinical studies and the range of cancer sites in which US motion management is applied. Also reviewed are selections of existing and proposed novel applications of US imaging to RT. These are driven by exciting developments in structural, functional and molecular US imaging and analytical techniques such as backscatter tissue analysis, elastography, photoacoustography, contrast-specific imaging, dynamic contrast analysis, microvascular and super-resolution imaging, and targeted microbubbles. Such techniques show promise for predicting and measuring the outcome of RT, quantifying normal tissue toxicity, improving tumour definition and defining a biological target volume that describes radiation sensitive regions of the tumour. US offers easy, low cost and efficient integration of these techniques into the RT workflow. US contrast technology also has potential to be used actively to assist RT by manipulating the tumour cell environment and by improving the delivery of radiosensitising agents. Finally, US imaging offers various ways to measure dose in 3D. If technical problems can be overcome, these hold potential for wide-dissemination of cost-effective pre-treatment dose verification and in vivo dose monitoring methods. It is concluded that US imaging could eventually contribute to all aspects of the RT workflow.

Acoustic resolution photoacoustic Doppler velocimetry in blood-mimicking fluids

Photoacoustic Doppler velocimetry provides a major opportunity to overcome limitations of existing blood flow measuring methods. By enabling measurements with high spatial resolution several millimetres deep in tissue, it could probe microvascular blood flow abnormalities characteristic of many different diseases. Although previous work has demonstrated feasibility in solid phantoms, measurements in blood have proved significantly more challenging. This difficulty is commonly attributed to the requirement that the absorber spatial distribution is heterogeneous relative to the minimum detectable acoustic wavelength. By undertaking a rigorous study using blood-mimicking fluid suspensions of 3 μm absorbing microspheres, it was discovered that the perceived heterogeneity is not only limited by the intrinsic detector bandwidth; in addition, bandlimiting due to spatial averaging within the detector field-of-view also reduces perceived heterogeneity and compromises velocity measurement accuracy. These detrimental effects were found to be mitigated by high-pass filtering to select photoacoustic signal components associated with high heterogeneity. Measurement under-reading due to limited light penetration into the flow vessel was also observed. Accurate average velocity measurements were recovered using "range-gating", which furthermore maps the cross-sectional velocity profile. These insights may help pave the way to deep-tissue non-invasive mapping of microvascular blood flow using photoacoustic methods.

Pulsed photoacoustic flow imaging with a handheld system

Flow imaging is an important technique in a range of disease areas, but estimating low flow speeds, especially near the walls of blood vessels, remains challenging. Pulsed photoacoustic flow imaging can be an alternative since there is little signal contamination from background tissue with photoacoustic imaging. We propose flow imaging using a clinical photoacoustic system that is both handheld and portable. The system integrates a linear array with 7.5 MHz central frequency in combination with a high-repetition-rate diode laser to allow high-speed photoacoustic imaging--ideal for this application. This work shows the flow imaging performance of the system in vitro using microparticles. Both two-dimensional (2-D) flow images and quantitative flow velocities from 12 to 75  mm/s were obtained. In a transparent bulk medium, flow estimation showed standard errors of ∼7% the estimated speed; in the presence of tissue-realistic optical scattering, the error increased to 40% due to limited signal-to-noise ratio. In the future, photoacoustic flow imaging can potentially be performed in vivo using fluorophore-filled vesicles or with an improved setup on whole blood.

Performance comparison of rigid and affine models for motion estimation using ultrasound radio-frequency signals

Tissue motion estimation is widely used in many ultrasound techniques. Rigid-model-based and nonrigid-modelbased methods are two main groups of space-domain methods of tissue motion estimation. The affine model is one of the commonly used nonrigid models. The performances of the rigid model and affine model have not been compared on ultrasound RF signals, which have been demonstrated to obtain higher accuracy, precision, and resolution in motion estimation compared with B-mode images. In this study, three methods, i.e., the normalized cross-correlation method with rigid model (NCC), the optical flow method with rigid model (OFRM), and the optical flow method with affine model (OFAM), are compared using ultrasound RF signals, rather than the B-mode images used in previous studies. Simulations, phantom, and in vivo experiments are conducted to make the comparison. In the simulations, the root-mean-square errors (RMSEs) of axial and lateral displacements and strains are used to assess the accuracy of motion estimation, and the elastographic signal-tonoise ratio (SNRe) and contrast-to-noise ratio (CNRe) are used to evaluate the quality of axial strain images. In the phantom experiments, the registration error between the pre- and postdeformation RF signals, as well as the SNRe and CNRe of axial strain images, are utilized as the evaluation criteria. In the in vivo experiments, the registration error is used to evaluate the estimation performance. The results show that the affinemodel- based method (i.e., OFAM) obtains the lowest RMSE or registration error and the highest SNRe and CNRe among all the methods. The affine model is demonstrated to be superior to the rigid model in motion estimation based on RF signals.

In vivo lateral blood flow velocity measurement using speckle size estimation

In previous studies, we proposed blood measurement using speckle size estimation, which estimates the lateral component of blood flow within a single image frame based on the observation that the speckle pattern corresponding to blood reflectors (typically red blood cells) stretches (i.e., is "smeared") if blood flow is in the same direction as the electronically controlled transducer line selection in a 2-D image. In this observational study, the clinical viability of ultrasound blood flow velocity measurement using speckle size estimation was investigated and compared with that of conventional spectral Doppler of carotid artery blood flow data collected from human patients in vivo. Ten patients (six male, four female) were recruited. Right carotid artery blood flow data were collected in an interleaved fashion (alternating Doppler and B-mode A-lines) with an Antares Ultrasound Imaging System and transferred to a PC via the Axius Ultrasound Research Interface. The scanning velocity was 77 cm/s, and a 4-s interval of flow data were collected from each subject to cover three to five complete cardiac cycles. Conventional spectral Doppler data were collected simultaneously to compare with estimates made by speckle size estimation. The results indicate that the peak systolic velocities measured with the two methods are comparable (within ±10%) if the scan velocity is greater than or equal to the flow velocity. When scan velocity is slower than peak systolic velocity, the speckle stretch method asymptotes to the scan velocity. Thus, the speckle stretch method is able to accurately measure pure lateral flow, which conventional Doppler cannot do. In addition, an initial comparison of the speckle size estimation and color Doppler methods with respect to computational complexity and data acquisition time indicated potential time savings in blood flow velocity estimation using speckle size estimation. Further studies are needed for calculation of the speckle stretch method across a field of view and combination with an appropriate axial flow estimator.

A two-step optical flow method for strain estimation in elastography: Simulation and phantom study

Optical flow (OF) method has been used in ultrasound elastography to estimate the strain distribution in tissues. However the bias of strain estimation by OF has previously been shown to be close to 20%. The objective in this paper is to improve the performance of OF-based strain estimation, a two-step OF method with a local warping technique is proposed in this paper. The local warping technique effectively decreases the decorrelation of the signals, and hence improves the performance of strain estimation. Simulations on both homogeneous and heterogeneous models with different strains are performed. Experiments on a heterogeneous tissue-mimicking phantom are also carried out. Simulation results of the homogeneous model show that the two-step OF method reduces the bias of strain estimation from 23.77% to 1.65%, and reduces the standard deviation of strain estimation from 2.9×10(-3) to 0.47×10(-3). Simulation results of the heterogeneous model shows that the signals-to-noise ratio (SNRe) of strain estimation is improved by 2.1 and 5.3dB in the inclusion and background, respectively, and the contrast-to-noise ratio (CNRe) is improved by 6.8dB. Finally, results of phantom experiments show that, by using the proposed method, the SNRe is increased by 4.0dB and 8.9dB in the inclusion and background, respectively, while the CNRe is increased by 13.1dB. The proposed two-step OF method is thus demonstrated capable of improving the performance of strain estimation in OF-based elastography.

In Vivo response to compression of 35 breast lesions observed with a two-dimensional locally regularized strain estimation method

The objective of this study was to assess the in vivo performance of our 2-D locally regularized strain estimation method with 35 breast lesions, mainly cysts, fibroadenomas and carcinomas. The specific 2-D deformation model used, as well as the method's adaptability, led to an algorithm that is able to track tissue motion from radiofrequency ultrasound images acquired in clinical conditions. Particular attention was paid to strain estimation reliability, implying analysis of the mean normalized correlation coefficient maps. For all lesions examined, the results indicated that strain image interpretation, as well as its comparison with B-mode data, should take into account the information provided by the mean normalized correlation coefficient map. Different trends were observed in the tissue response to compression. In particular, carcinomas appeared larger in strain images than in B-mode images, resulting in a mean strain/B-mode lesion area ratio of 2.59 ± 1.36. In comparison, the same ratio was assessed as 1.04 ± 0.26 for fibroadenomas. These results are in agreement with those of previous studies, and confirm the interest of a more thorough consideration of size difference as one parameter discriminating between malignant and benign lesions.

New universal strain software accurately assesses cardiac systolic and diastolic function using speckle tracking echocardiography

BACKGROUND

We have developed new universal strain software (USS) that can be used to perform speckle tracking of any Digital Imaging and Communications in Medicine (DICOM) image, regardless of the ultrasound system used to obtain it.

METHODS

Fifty patients prospectively underwent echocardiography immediately prior to cardiac catheterization. Biplane peak global longitudinal strain (GLS), peak systolic longitudinal strain rate (SSR), peak early diastolic longitudinal strain rate (DSR), and peak early diastolic circumferential strain rate (DCSR) were determined using conventional strain software (CSS) that uses raw data, and using the new USS applied to DICOM images.

RESULTS

Universal strain software correlated with CSS for GLS (r = 0.78, P < 0.001), SSR (r = 0.78, P < 0.001), DSR (r = 0.54, P < 0.001), and DCSR (r = 0.43, P = 0.019). GLS and SSR using USS correlated with left ventricular ejection fraction (LVEF) (r = -0.67 and -0.71, respectively) as well as using CSS (r = -0.66 and -0.71). Patients with diastolic dysfunction had significantly lower DSR (0.61 vs. 0.87/sec, P = 0.02) and DCSR (0.89 vs. 1.23/sec, P = 0.03), and less negative GLS (-10.8 vs. -16.1%, P = 0.002) using USS in all patients, as well as among those with LVEF ≥ 50%. Receiver-operating characteristic (ROC) analysis for detection of diastolic dysfunction revealed a sensitivity and specificity of 82% and 83% for DCSR < 1.09/sec (area under the curve [AUC = 0.80]) and 85% and 83% for GLS > -13.7% (AUC = 0.84) using USS.

CONCLUSION

Universal strain software can be used to accurately assess LV systolic and diastolic function using speckle tracking echocardiography.

Image-guided non-invasive ultrasound liver ablation using histotripsy: feasibility study in an in vivo porcine model

Hepatocellular carcinoma (HCC), or liver cancer, is one of the fastest growing cancers in the United States. Current liver ablation methods are thermal based and share limitations resulting from the heat sink effect of blood flow through the highly vascular liver. In this study, we explore the feasibility of using histotripsy for non-invasive liver ablation in the treatment of liver cancer. Histotripsy is a non-thermal ablation method that fractionates soft tissue through the control of acoustic cavitation. Twelve histotripsy lesions ∼1 cm(3) were created in the livers of six pigs through an intact abdomen and chest in vivo. Histotripsy pulses of 10 cycles, 500-Hz pulse repetition frequency (PRF), and 14- to 17-MPa estimated in situ peak negative pressure were applied to the liver using a 1-MHz therapy transducer. Treatments were performed through 4-6 cm of overlying tissue, with 30%-50% of the ultrasound pathway covered by the rib cage. Complete fractionation of liver parenchyma was observed, with sharp boundaries after 16.7-min treatments. In addition, two larger volumes of 18 and 60 cm(3) were generated within 60 min in two additional pigs. As major vessels and gallbladder have higher mechanical strength and are more resistant to histotripsy, these remained intact while the liver surrounding these structures was completely fractionated. This work shows that histotripsy is capable of non-invasively fractionating liver tissue while preserving critical anatomic structures within the liver. Results suggest histotripsy has potential for the non-invasive ablation of liver tumors.

Two-dimensional blood flow velocity estimation using ultrasound speckle pattern dependence on scan direction and A-line acquisition velocity

We have previously investigated the change of apparent lateral speckle size caused by the direction and spatial rate of scanner A-line acquisition (scan velocity). An algorithm which measures the lateral component of blood flow velocity was developed based on the increase in speckle size resulting from relative motion between moving scatterers and the scan velocity. In this paper, the change of the apparent dominant angle of the speckle pattern in a straight vessel was investigated and a new method of two-dimensional blood flow velocity estimation is introduced. Different scan velocities were used for data acquisition from blood flow traveling at an angle relative to the ultrasound beam. The apparent angle of the speckle pattern changes with different scan velocities because of misregistration between the ultrasound beam and scatterers. The apparent angle of the speckle pattern was resolved by line-to-line cross-correlation in the fast-time (axial) direction on a region-of-interest (ROI) in each blood flow image and used to spatially align the ROI. The resulting lateral speckle size within the aligned ROI was calculated. The lateral component of the blood flow is shown to be closest to the scan velocity which gives the maximum speckle size and the apparent angle of speckle pattern collected by this scan velocity is the best estimate for the actual angle of blood flow. These two components produce two-dimensional blood flow velocity estimations. This method was studied through both computer simulation and experiments with a blood flow phantom. Nine scan velocities were used to collect blood flow data with velocities ranging from 33 to 98 cm/s and four beam-to-flow angles. In simulated plug blood flow, the mean bias of angle estimation is below 2% with an average standard deviation of 3.6%. In simulated parabolic blood flow, the angle of blood flow is overestimated because of speckle decorrelation caused by flow gradients and the estimation bias increases with decreasing beam-to-flow angle, which has an average value of 8.8% and standard deviation of 10%. Because of the complexity of flow profiles in the blood flow phantom, the angle of blood flow is also overestimated and the mean bias is increased by a factor of two compared with simulated parabolic flow. For the velocity estimation results, the mean bias is below 5% with an average standard deviation of 4.6% in the simulated plug blood flow. In the simulated parabolic flow and blood flow phantom, the velocity is underestimated because of speckle decorrelation. The mean bias of velocity estimation in the simulated parabolic flow is -6% with an average standard deviation of 11.2%. In the blood flow phantom, the mean bias of the velocity estimation is -5% with a higher average standard deviation of 21.5%. This method can resolve the angle and amplitude of two-dimensional blood flow simultaneously. The accuracy of the estimation can be further improved by using more scanning velocities.

Fast reconstruction of tissue elastic modulus image by ultrasound

Most technologies for tissue elasticity imaging are now based on measurement of stain distribution, since they are more suited to real-time processing than reconstruction of elastic modulus images. However, to obtain more quantitative information about tissue elastic properties, it is necessary to reconstruct tissue elastic modulus images. There, we developed a new method for reconstructing tissue elastic modulus images at high speed and with high precision based on a modified 3-D finite-element model. In this paper, we verify the validity of the method based on a modified 3-D finite-element model, using simulations and phantom experiments.

Decision of Cirrhosis Using Liver's Ultrasonic Images

Feature extraction techniques in the ultrasonic images of a liver were studied firstly. As an initial result, total 25 parameters relating to cirrhosis were extracted. They were obtained from the motion curve of the liver in an M-mode image, and from the texture using a B-mode image. Then the efficiency of every parameter was analyzed, and with the use of a feature fusion method a set of 20 useful features was picked out. With these chosen features, a noninvasive automatic decision system for cirrhosis was constructed based on a Fisher linear decision criterion. The clinical application for 43 cases showed that this quantitative system was effective in the diagnosis of cirrhosis.

Monitoring airway mucus flow and ciliary activity with optical coherence tomography

Muco-ciliary transport in the human airway is a crucial defense mechanism for removing inhaled pathogens. Optical coherence tomography (OCT) is well-suited to monitor functional dynamics of cilia and mucus on the airway epithelium. Here we demonstrate several OCT-based methods upon an actively transporting in vitro bronchial epithelial model and ex vivo mouse trachea. We show quantitative flow imaging of optically turbid mucus, semi-quantitative analysis of the ciliary beat frequency, and functional imaging of the periciliary layer. These may translate to clinical methods for endoscopic monitoring of muco-ciliary transport in diseases such as cystic fibrosis and chronic obstructive pulmonary disease (COPD).

Pulsed photoacoustic Doppler flowmetry using time-domain cross-correlation: accuracy, resolution and scalability

The feasibility of making spatially resolved measurements of blood velocity using a pulsed photoacoustic Doppler technique in acoustic resolution mode has been investigated. Doppler time shifts were quantified via cross-correlation of photoacoustic waveform pairs generated within a blood-simulating phantom using pairs of light pulses. The phantom comprised micron-scale absorbers imprinted on an acetate sheet and moved at known velocities. The photoacoustic waves were detected using PZT ultrasound transducers operating at center frequencies of 20 MHz, 5 MHz and 3.5 MHz; measurements of velocity and resolution were calculated from the mean cross-correlation function of 25 waveform pairs. Velocities in the range ±0.15 to ±1.5 ms(-1) were quantified with accuracies as low as 1%. The transducer focal beam width determines a maximum measurable velocity |V(max)| beyond which correlation is lost due to absorbers moving out of the focal beam between the two laser pulses. Below |V(max)| a measurement resolution of <4% of the measured velocity was achieved. Resolution and |V(max)| can be scaled to much lower velocities such as those encountered in microvasculature (< 50 mms(-1)). The advantage of pulsed rather than continuous-wave excitation is that spatially resolved velocity measurements can be made, offering the prospect of mapping flow within the microcirculation.

Physiologic cardiovascular strain and intrinsic wave imaging

Cardiovascular disease remains the primary killer worldwide. The heart, essentially an electrically driven mechanical pump, alters its mechanical and electrical properties to compensate for loss of normal mechanical and electrical function. The same adjustment also is performed in the vessels, which constantly adapt their properties to accommodate mechanical and geometrical changes related to aging or disease. Real-time, quantitative assessment of cardiac contractility, conduction, and vascular function before the specialist can visually detect it could be feasible. This new physiologic data could open up interactive therapy regimens that are currently not considered. The eventual goal of this technology is to provide a specific method for estimating the position and severity of contraction defects in cardiac infarcts or angina. This would improve care and outcomes as well as detect stiffness changes and overcome the current global measurement limitations in the progression of vascular disease, at little more cost or risk than that of a clinical ultrasound.

Split-spectrum amplitude-decorrelation angiography with optical coherence tomography

Amplitude decorrelation measurement is sensitive to transverse flow and immune to phase noise in comparison to Doppler and other phase-based approaches. However, the high axial resolution of OCT makes it very sensitive to the pulsatile bulk motion noise in the axial direction. To overcome this limitation, we developed split-spectrum amplitude-decorrelation angiography (SSADA) to improve the signal-to-noise ratio (SNR) of flow detection. The full OCT spectrum was split into several narrower bands. Inter-B-scan decorrelation was computed using the spectral bands separately and then averaged. The SSADA algorithm was tested on in vivo images of the human macula and optic nerve head. It significantly improved both SNR for flow detection and connectivity of microvascular network when compared to other amplitude-decorrelation algorithms.

Ultrasonic wave propagation assessment of native cartilage explants and hydrogel scaffolds for tissue engineering

Non-destructive techniques characterising the mechanical properties of cells, tissues, and biomaterials provide baseline metrics for tissue engineering design. Ultrasonic wave propagation and attenuation has previously demonstrated the dynamics of extracellular matrix synthesis in chondrocyte-seeded hydrogel constructs. In this paper, we describe an ultrasonic method to analyse two of the construct elements used to engineer articular cartilage in real-time, native cartilage explants and an agarose biomaterial. Results indicated a similarity in wave propagation velocity ranges for both longitudinal (1500-1745 m/s) and transverse (350-950 m/s) waveforms. Future work will apply an acoustoelastic analysis to distinguish between the fluid and solid properties including the cell and matrix biokinetics as a validation of previous mathematical models.

Analysis of 2-D motion tracking in ultrasound with dual transducers

We study displacement and strain measurement error of dual transducers (two linear arrays, aligned orthogonally and coplanar). Displacements along the beam of each transducer are used to obtain measurements in two-dimensions. Simulations (5MHz) and experiments (10MHz) are compared to measurements with a single linear array, with and without angular compounding. Translation simulations demonstrate factors of 1.07 larger and 8.0 smaller biases in the axial and lateral directions respectively, for dual transducers compared to angular compounding. As the angle between dual transducers decreases from 90° to 40°, for 1% compression simulations, the lateral RMS error ranges from 2.1 to 3.9μm compared to 9μm with angular compounding. Simulation of dual transducer misalignment of 1mm and 2° result in errors of less than 9μm. Experiments demonstrate factors of 3.0 and 5.2 lower biases for dual transducers in the axial and lateral directions respectively compared to angular compounding.

Ultrasonic colour Doppler imaging

Ultrasonic colour Doppler is an imaging technique that combines anatomical information derived using ultrasonic pulse-echo techniques with velocity information derived using ultrasonic Doppler techniques to generate colour-coded maps of tissue velocity superimposed on grey-scale images of tissue anatomy. The most common use of the technique is to image the movement of blood through the heart, arteries and veins, but it may also be used to image the motion of solid tissues such as the heart walls. Colour Doppler imaging is now provided on almost all commercial ultrasound machines, and has been found to be of great value in assessing blood flow in many clinical conditions. Although the method for obtaining the velocity information is in many ways similar to the method for obtaining the anatomical information, it is technically more demanding for a number of reasons. It also has a number of weaknesses, perhaps the greatest being that in conventional systems, the velocities measured and thus displayed are the components of the flow velocity directly towards or away from the transducer, while ideally the method would give information about the magnitude and direction of the three-dimensional flow vectors. This review briefly introduces the principles behind colour Doppler imaging and describes some clinical applications. It then describes the basic components of conventional colour Doppler systems and the methods used to derive velocity information from the ultrasound signal. Next, a number of new techniques that seek to overcome the vector problem mentioned above are described. Finally, some examples of vector velocity images are presented.

Biomedical photoacoustic imaging

Photoacoustic (PA) imaging, also called optoacoustic imaging, is a new biomedical imaging modality based on the use of laser-generated ultrasound that has emerged over the last decade. It is a hybrid modality, combining the high-contrast and spectroscopic-based specificity of optical imaging with the high spatial resolution of ultrasound imaging. In essence, a PA image can be regarded as an ultrasound image in which the contrast depends not on the mechanical and elastic properties of the tissue, but its optical properties, specifically optical absorption. As a consequence, it offers greater specificity than conventional ultrasound imaging with the ability to detect haemoglobin, lipids, water and other light-absorbing chomophores, but with greater penetration depth than purely optical imaging modalities that rely on ballistic photons. As well as visualizing anatomical structures such as the microvasculature, it can also provide functional information in the form of blood oxygenation, blood flow and temperature. All of this can be achieved over a wide range of length scales from micrometres to centimetres with scalable spatial resolution. These attributes lend PA imaging to a wide variety of applications in clinical medicine, preclinical research and basic biology for studying cancer, cardiovascular disease, abnormalities of the microcirculation and other conditions. With the emergence of a variety of truly compelling in vivo images obtained by a number of groups around the world in the last 2-3 years, the technique has come of age and the promise of PA imaging is now beginning to be realized. Recent highlights include the demonstration of whole-body small-animal imaging, the first demonstrations of molecular imaging, the introduction of new microscopy modes and the first steps towards clinical breast imaging being taken as well as a myriad of in vivo preclinical imaging studies. In this article, the underlying physical principles of the technique, its practical implementation, and a range of clinical and preclinical applications are reviewed.

Biomedical photoacoustic imaging

Photoacoustic (PA) imaging, also called optoacoustic imaging, is a new biomedical imaging modality based on the use of laser-generated ultrasound that has emerged over the last decade. It is a hybrid modality, combining the high-contrast and spectroscopic-based specificity of optical imaging with the high spatial resolution of ultrasound imaging. In essence, a PA image can be regarded as an ultrasound image in which the contrast depends not on the mechanical and elastic properties of the tissue, but its optical properties, specifically optical absorption. As a consequence, it offers greater specificity than conventional ultrasound imaging with the ability to detect haemoglobin, lipids, water and other light-absorbing chomophores, but with greater penetration depth than purely optical imaging modalities that rely on ballistic photons. As well as visualizing anatomical structures such as the microvasculature, it can also provide functional information in the form of blood oxygenation, blood flow and temperature. All of this can be achieved over a wide range of length scales from micrometres to centimetres with scalable spatial resolution. These attributes lend PA imaging to a wide variety of applications in clinical medicine, preclinical research and basic biology for studying cancer, cardiovascular disease, abnormalities of the microcirculation and other conditions. With the emergence of a variety of truly compelling in vivo images obtained by a number of groups around the world in the last 2-3 years, the technique has come of age and the promise of PA imaging is now beginning to be realized. Recent highlights include the demonstration of whole-body small-animal imaging, the first demonstrations of molecular imaging, the introduction of new microscopy modes and the first steps towards clinical breast imaging being taken as well as a myriad of in vivo preclinical imaging studies. In this article, the underlying physical principles of the technique, its practical implementation, and a range of clinical and preclinical applications are reviewed.

Arterial diameter measurement using high resolution ultrasonography: in vitro validation

Simultaneous measurement of pressure and diameter in blood vessels or vascular prosthesis is of great importance in cardiovascular research. Knowledge of diameter changes as response to intravascular pressure is the basis to estimate the biomechanical properties of blood vessel. In this work a new method to quantify arterial diameter based in high resolution ultrasonography is proposed. Measurements on an arterial phantom placed on a cardiovascular simulator were performed. The results were compared to sonomicrometry measurements considered as gold standard technique. The obtained results indicate that the new method ensure an optimal diameter quantification. This method presents two main advantages respect to sonomicrometry: is noninvasive and the vessel wall strain can be measured directly.

A Virtual Instrument for Automated Measurement of Arterial Compliance

Measurement of arterial distensibility is very important in cardiovascular diagnosis for early detection of coronary heart disease and possible prediction of future cardiac events. Conventionally, B-mode ultrasound imaging systems have been used along with expensive vessel wall tracking systems for estimation of arterial distension and calculation of various estimates of compliance. We present a simple instrument for noninvasive in vivo evaluation of arterial compliance using a single element ultrasound transducer. The measurement methodology is initially validated using a proof of concept pilot experiment using a commercial ultrasound pulser-receiver. A prototype system is then developed around a PXI chassis using LABVIEW software. The virtual instrument employs a dynamic threshold algorithm to identify the artery walls and then utilizes a correlation based tracking technique to estimate arterial distension. The end-diastolic echo signals are averaged to reduce error in the automated diameter measurement process. The instrument allows automated measurement of the various measures of arterial compliance with minimal operator intervention. The performance of the virtual instrument was first analyzed using simulated data sets to establish the maximum measurement accuracy achievable under different input signal to noise ratio (SNR) levels. The system could measure distension with accuracy better than 10 μm for positive SNR. The measurement error in diameter was less than 1%. The system was then thoroughly evaluated by the experiments conducted on phantom models of the carotid artery and the accuracy and resolution were found to meet the requirements of the application. Measurements performed on human volunteers indicate that the instrument can measure arterial distension with a precision better than 5%. The end-diastolic arterial diameter can be measured with a precision better than 2% and an accuracy of 1%. The measurement system could lead to the development of small, portable, and inexpensive equipment for estimation of arterial compliance suitable in mass screening of “at risk” patients. The automated compliance measurement algorithm implemented in the instrument requires minimal operator input. The instrument could pave the way for dedicated systems for arterial compliance evaluation targeted at the general medical practitioner who has little or no expertise in vascular ultrasonography.

Lateral blood flow velocity estimation based on ultrasound speckle size change with scan velocity

Conventional (Doppler-based) blood flow velocity measurement methods using ultrasound are capable of resolving the axial component (i.e., that aligned with the ultrasound propagation direction) of the blood flow velocity vector. However, these methods are incapable of detecting blood flow in the direction normal to the ultrasound beam. In addition, these methods require repeated pulse-echo interrogation at the same spatial location. A new method has been introduced which estimates the lateral component of blood flow within a single image frame using the observation that the speckle pattern corresponding to blood reflectors (typically red blood cells) stretches (i.e., is smeared) if the blood is moving in the same direction as the electronically-controlled transducer line selection in a 2-D image. The situation is analogous to the observed distortion of a subject photographed with a moving camera. The results of previous research showed a linear relationship between the stretch factor (increase in lateral speckle size) and blood flow velocity. However, errors exist in the estimation when used to measure blood flow velocity. In this paper, the relationship between speckle size and blood flow velocity is investigated further with both simulated flow data and measurements from a blood flow phantom. It can be seen that: 1) when the blood flow velocity is much greater than the scan velocity (spatial rate of A-line acquisition), the velocity will be significantly underestimated because of speckle decorrelation caused by quick blood movement out of the ultrasound beam; 2) modeled flow gradients increase the average estimation error from a range between 1.4% and 4.4%, to a range between 4.4% and 6.8%; and 3) estimation performance in a blood flow phantom with both flow gradients and random motion of scatterers increases the average estimation error to between 6.1% and 7.8%. Initial attempts at a multiple-scan strategy for estimating flow by a least-squares model suggest the possibility of increased accuracy using multiple scan velocities.

New noninvasive assessment of liver fibrosis in chronic hepatitis B: maximal accumulative respiration strain

OBJECTIVE

A novel parameter acquired from conventional B-mode sonographic videos was introduced in this study, and its diagnostic accuracy for evaluation of hepatic fibrosis was investigated.

METHODS

Twenty-eight patients with chronic hepatitis B and 8 patients with hepatic cysts in the right lobe (controls) were enrolled. B-mode sonographic videos of hepatic motion under the ensisternum in the sagittal plane were captured during peaceful breathing. Maximal accumulative respiration strain (MARS) values of hepatic tissue were obtained after image analysis. METAVIR scoring after liver biopsy was considered the standard. First, the relationship between MARS and the fibrotic stage was studied; and second, receiver operating characteristic (ROC) curves were used to assess the accuracy of MARS for evaluation of the fibrotic stage.

RESULTS

When the transducer was placed in the sagittal imaging plane under the ensisternum during the whole respiratory period, the hepatic tissue motion was almost in the same plane. The MARS values (mean +/- SD) were 29.44% +/- 10.44% in the F0 group (no fibrosis; n = 8), 19.30% +/- 9.10% in the F1 group (portal fibrosis without septa; n = 8), 18.09% +/- 7.36% in the F2-F3 group (portal fibrosis with few septa or numerous septa without cirrhosis; n = 12), and 14.16% +/- 4.18% in the F4 group (cirrhosis; n = 8). The Spearman correlation coefficient between MARS and the fibrotic stage was 0.516 (P = .001). The diagnostic accuracy rates, expressed as areas under the ROC curves, were 0.87 for mild fibrosis (F >or= 1), 0.72 for substantial fibrosis (F >or= 2), and 0.75 for cirrhosis (F = 4).

CONCLUSIONS

Maximal accumulative respiration strain attained from B-mode sonographic videos of hepatic tissue is a new, convenient, economical, and promising noninvasive parameter for assessment of hepatic fibrosis in patients with chronic hepatitis B.

3-D in vitro estimation of temperature using the change in backscattered ultrasonic energy

Temperature imaging with a non-invasive modality to monitor the heating of tumors during hyperthermia treatment is an attractive alternative to sparse invasive measurement. Previously, we predicted monotonic changes in backscattered energy (CBE) of ultrasound with temperature for certain sub-wavelength scatterers. We also measured CBE values similar to our predictions in bovine liver, turkey breast muscle, and pork rib muscle in 2-D in vitro studies and in nude mice during 2-D in vivo studies. To extend these studies to three dimensions, we compensated for motion and measured CBE in turkey breast muscle. 3-D data sets were assembled from images formed by a phased-array imager with a 7.5-MHz linear probe moved in 0.6-mm steps in elevation during uniform heating from 37 to 45 degrees C in 0.5 degrees C increments. We used cross-correlation as a similarity measure in RF signals to automatically track feature displacement as a function of temperature. Feature displacement was non-rigid. Envelopes of image regions, compensated for non-rigid motion, were found with the Hilbert transform then smoothed with a 3 x 3 running average filter before forming the backscattered energy at each pixel. CBE in 3-D motion-compensated images was nearly linear with an average sensitivity of 0.30 dB/ degrees C. 3-D estimation of temperature in separate tissue regions had errors with a maximum standard deviation of about 0.5 degrees C over 1-cm(3) volumes. Success of CBE temperature estimation based on 3-D non-rigid tracking and compensation for real and apparent motion of image features could serve as the foundation for the eventual generation of 3-D temperature maps in soft tissue in a non-invasive, convenient, and low-cost way in clinical hyperthermia.

A high-frame-rate ultrasound system for the study of tissue motions

In this article, a technique for measuring fast periodic motion is proposed. The sequencing used in this technique is similar to the one used in conventional color Doppler systems. However, a phase correction algorithm is introduced which compensates for the acquisition delays. Criteria for the types of motion which could be detected correctly by the system are developed and presented. Effective frame rates of several hundred hertz to a few kilohertz have been achieved with the system. Applications of the system in tissue elastography are presented together with experimental results from tissue mimicking phantoms.

Atherosclerotic plaque components characterization and macrophage infiltration identification by intravascular ultrasound elastography based on b-mode analysis: validation in vivo

Intravascular ultrasound elastography (IVUSE) is a promising imaging technique for early investigation of vulnerable plaques. Compared to radiofrequency signal processing, digital B-mode analysis is simple and of higher portability. However, rare studies have been reported validating the latter technique in vivo. In this study, we developed an IVUSE computer software system involving semi-automatic border delineation and block-matching algorithm and validated the system in vivo. Seven minipigs were fed with atherogenic diet for 40 weeks. For each pig, the endothelium of one side of the renal arteries was denuded at the fifth week. With cross-correlation analysis, Lagrangian strain was calculated from two intravascular ultrasound images acquired in situ. Sixty regions of interests were selected from 35 elastograms matched well with the corresponding histological slices. Plaque types within these regions were classified as fibrous, fibro-fatty or fatty on Masson's trichrome and Oil-red O staining. Macrophage infiltration was also evaluated with immunohistology. Comparison between the mean strain value of the region of interest and the histological results revealed significant differences in strain values among different plaque types and non-diseased artery walls. The extent of macrophage infiltration was found to be correlated positively with strain values. For identification of fibro-fatty and fibrous plaques and macrophage infiltration, the system showed high sensitivity (93, 96 and 92%, respectively) and specificity (89, 76 and 66%, respectively), as revealed by receiver operating characteristic analysis. Our IVUSE system based on B-mode analysis is capable of characterizing fibrous and fibro-fatty plaques and macrophage intensity, thus holds potential for identifying vulnerable plaque.