Quantifying local stiffness variations in radiofrequency ablations with dynamic indentation

Real-Time Elastography versus Shear Wave Elastography on Evaluating the Timely Radiofrequency Ablation Effect of Rabbit Liver: A Preliminary Experimental Study

Purpose: to evaluate and monitor the timely thermal ablation changes of rabbit liver by using two elastographic methods—real-time elastography (RTE) and shear wave elastography (SWE)—as compared to contrast-enhanced ultrasound (CEUS) and physical specimens. Materials and Methods: 20 ablation zones were created in the livers of 20 rabbits using radiofrequency ablation (RFA). After the ablation, RTE and SWE were used to measure the elastic properties of the twenty ablation zones. The consistency of efficacy evaluation for RTE and SWE measurements was analyzed using the Bland–Altman test. The areas of the thermal ablation zones were also measured and compared according to the images provided by RTE, SWE, CEUS, and gross physical specimen measurement. Results: RTE and SWE could clearly display the shape of RFA ablation zones within one hour after the ablation. The average elasticity ratio for the ablation zone measured by RTE was 3.41 ± 0.67 (2.23–4.76); the average elasticity value measured by SWE was 50.7 ± 11.3 kPa (33.2–70.4 kPa). The mean areas of the ablation zones measured with RTE, SWE, gross specimen, and CEUS were 1.089 ± 0.199 cm2, 1.059 ± 0.201 cm2, 1.081 ± 0.201 cm2, and 3.091 ± 0.591 cm2, respectively. The Bland–Altman test showed that RTE and SWE have great consistency. Area measurements by CEUS were significantly larger than those of the other three methods (p < 0.05). Conclusion: RTE and SWE are both able to accurately confirm the range of ablation zones shortly after the ablation for rabbit livers.

Thermo-Visco-Elastometry of RF-Wave-Heated and Ablated Flesh Tissues Containing Au Nanoparticles

We report non-contact laser-based Brillouin light-scattering (BLS) spectroscopy measurements of the viscoelastic properties of hyperthermally radiofrequency (RF)-heated and ablated bovine liver and chicken flesh tissues with embedded gold nanoparticles (AuNPs). The spatial lateral profile of the local surface temperature in the flesh samples during their hyperthermia was measured through optical backscattering reflectometry (OBR) using Mg−silica-NP-doped sensing fibers distributed with an RF applicator and correlated with viscoelastic variations in heat-affected and ablated tissues. Substantial changes in the tissue stiffness after heating and ablation were directly related to their heat-induced structural modifications. The main proteins responsible for muscle elasticity were denatured and irreversibly aggregated during the RF ablation. At T > 100 °C, the proteins constituting the flesh further shrank and became disorganized, leading to substantial plastic deformation of biotissues. Their uniform destruction with larger thermal lesions and a more viscoelastic network was attained via AuNP-mediated RF hyperthermal ablation. The results demonstrated here pave the way for simultaneous real-time hybrid optical sensing of viscoelasticity and local temperature in biotissues during their denaturation and gelation during hyperthermia for future applications that involve mechanical- and thermal-property-controlled theranostics.

A Review of Quantitative Ultrasound-Based Approaches to Thermometry and Ablation Zone Identification Over the Past Decade

Percutaneous thermal therapy is an important clinical treatment method for some solid tumors. It is critical to use effective image visualization techniques to monitor the therapy process in real time because precise control of the therapeutic zone directly affects the prognosis of tumor treatment. Ultrasound is used in thermal therapy monitoring because of its real-time, non-invasive, non-ionizing radiation, and low-cost characteristics. This paper presents a review of nine quantitative ultrasound-based methods for thermal therapy monitoring and their advances over the last decade since 2011. These methods were analyzed and compared with respect to two applications: ultrasonic thermometry and ablation zone identification. The advantages and limitations of these methods were compared and discussed, and future developments were suggested.

Differential Imaging of Liver Tumors before and after Microwave Ablation with Electrode Displacement Elastography

Liver cancer is a leading cause of cancer-related deaths; however, primary treatment options such as surgical resection and liver transplant may not be viable for many patients. Minimally invasive image-guided microwave ablation (MWA) provides a locally effective treatment option for these patients with an impact comparable to that of surgery for both cancer-specific and overall survival. MWA efficacy is correlated with accurate image guidance; however, conventional modalities such as B-mode ultrasound and computed tomography have limitations. Alternatively, ultrasound elastography has been used to demarcate post-ablation zones, yet has limitations for pre-ablation visualization because of variability in strain contrast between cancer types. This study attempted to characterize both pre-ablation tumors and post-ablation zones using electrode displacement elastography (EDE) for 13 patients with hepatocellular carcinoma or liver metastasis. Typically, MWA ablation margins of 0.5-1.0 cm are desired, which are strongly correlated with treatment efficacy. Our results revealed an average estimated ablation margin inner quartile range of 0.54-1.21 cm with a median value of 0.84 cm. These treatment margins lie within or above the targeted ablative margin, indicating the potential to use EDE for differentiating index tumors and ablated zones during clinical ablations. We also obtained a high correlation between corresponding segmented cross-sectional areas from contrast-enhanced computed tomography, the current clinical gold standard, when compared with EDE strain images, with r2 values of 0.97 and 0.98 for pre- and post-ablation regions.

A kernel smoothing algorithm for ablation visualization in ultrasound elastography

Three-dimensional visualization of tumor ablation procedures have significant clinical value because the ability to accurately visualize ablated volumes can help clinicians gauge the extent of ablated tissue necrosis and plan future treatment steps. Better control over ablation volume can prevent recurrence of tumors treated using ablative procedures. This paper presents a kernel based smoothing algorithm called MatérnSmooth to reconstruct shear wave velocity maps from data acquired through ultrasound electrode vibration elastography. Shear wave velocity estimates are acquired on several intersecting imaging planes that share a common axis of intersection collinear with the ablation needle. An objective method of choosing smoothing parameters from underlying data is outlined through simulations. Experimental validation was performed on data acquired from a tissue mimicking phantom. Volume estimates were found to be within 20% of the true value.

Lesion modeling, characterization, and visualization for image-guided cardiac ablation therapy monitoring

In spite of significant efforts to improve image-guided ablation therapy, a large number of patients undergoing ablation therapy to treat cardiac arrhythmic conditions require repeat procedures. The delivery of insufficient thermal dose is a significant contributor to incomplete tissue ablation, in turn leading to the arrhythmia recurrence. Ongoing research efforts aim to better characterize and visualize RF delivery to monitor the induced tissue damage during therapy. Here, we propose a method that entails modeling and visualization of the lesions in real-time. The described image-based ablation model relies on classical heat transfer principles to estimate tissue temperature in response to the ablation parameters, tissue properties, and duration. The ablation lesion quality, geometry, and overall progression are quantified on a voxel-by-voxel basis according to each voxel's cumulative temperature and time exposure. The model was evaluated both numerically under different parameter conditions, as well as experimentally, using ex vivo bovine tissue samples undergoing ex vivo clinically relevant ablation protocols. The studies demonstrated less than 5°C difference between the model-predicted and experimentally measured end-ablation temperatures. The model predicted lesion patterns were within 0.5 to 1 mm from the observed lesion patterns, suggesting sufficiently accurate modeling of the ablation lesions. Lastly, our proposed method enables therapy delivery feedback with no significant workflow latency. This study suggests that the proposed technique provides reasonably accurate and sufficiently fast visualizations of the delivered ablation lesions.

Modeling Ramp-hold Indentation Measurements based on Kelvin-Voigt Fractional Derivative Model

Interpretation of experimental data from micro- and nano-scale indentation testing is highly dependent on the constitutive model selected to relate measurements to mechanical properties. The Kelvin-Voigt Fractional Derivative model (KVFD) offers a compact set of viscoelastic features appropriate for characterizing soft biological materials. This paper provides a set of KVFD solutions for converting indentation testing data acquired for different geometries and scales into viscoelastic properties of soft materials. These solutions, which are mostly in closed-form, apply to ramp-hold relaxation, load-unload and ramp-load creep-testing protocols. We report on applications of these model solutions to macro- and nano-indentation testing of hydrogels, gastric cancer cells and ex vivo breast tissue samples using an Atomic Force Microscope (AFM). We also applied KVFD models to clinical ultrasonic breast data using a compression plate as required for elasticity imaging. Together the results show that KVFD models fit a broad range of experimental data with a correlation coefficient typically R2 > 0.99. For hydrogel samples, estimation of KVFD model parameters from test data using spherical indentation versus plate compression as well as ramp relaxation versus load-unload compression all agree within one standard deviation. Results from measurements made using macro- and nano-scale indentation agree in trend. For gastric cell and ex vivo breast tissue measurements, KVFD moduli are, respectively, 1/3 - 1/2 and 1/6 of the elasticity modulus found from the Sneddon model. In vivo breast tissue measurements yield model parameters consistent with literature results. The consistency of results found for a broad range of experimental parameters suggest the KVFD model is a reliable tool for exploring intrinsic features of the cell/tissue microenvironments.

Efficient 3-D Reconstruction in Ultrasound Elastography via a Sparse Iteration Based on Markov Random Fields

Percutaneous needle-based liver ablation procedures are becoming increasingly common for the treatment of small isolated tumors in hepatocellular carcinoma patients who are not candidates for surgery. Rapid 3-D visualization of liver ablations has potential clinical value, because it can enable interventional radiologists to plan and execute needle-based ablation procedures with real time feedback. Ensuring the right volume of tissue is ablated is desirable to avoid recurrence of tumors from residual untreated cancerous cells. Shear wave velocity (SWV) measurements can be used as a surrogate for tissue stiffness to distinguish stiffer ablated regions from softer untreated tissue. This paper extends the previously reported sheaf reconstruction method to generate complete 3-D visualizations of SWVs without resorting to an approximate intermediate step of reconstructing transverse C planes. The noisy data are modeled using a Markov random field, and a computationally tractable reconstruction algorithm that can handle grids with millions of points is developed. Results from simulated ellipsoidal inclusion data show that this algorithm outperforms standard nearest neighbor interpolation by an order of magnitude in mean squared reconstruction error. Results from the phantom experiments show that it also provides a higher contrast-to-noise ratio by almost 2 dB and better signal-to-noise ratio in the stiff inclusion by over 2 dB compared with nearest neighbor interpolation and has lower computational complexity than linear and spline interpolation.

Radio Frequency Ultrasound Time Series Signal Analysis to Evaluate High-intensity Focused Ultrasound Lesion Formation Status in Tissue

High-intensity focused ultrasound (HIFU) is a novel treatment modality used by scientists and clinicians in the recent decades. This modality has had a great and significant success as a noninvasive surgery technique applicable in tissue ablation therapy and cancer treatment. In this study, radio frequency (RF) ultrasound signals were acquired and registered in three stages of before, during, and after HIFU exposures. Different features of RF time series signals including the sum of amplitude spectrum in the four quarters of the frequency range, the slope, and intercept of the best-fit line to the entire power spectrum and the Shannon entropy were utilized to distinguish between the HIFU-induced thermal lesion and the normal tissue. We also examined the RF data, frame by frame to identify exposure effects on the formation and characteristics of a HIFU thermal lesion at different time steps throughout the treatment. The results obtained showed that the spectrum frequency quarters and the slope and intercept of the best fit line to the entire power spectrum both increased two times during the HIFU exposures. The Shannon entropy, however, decreased after the exposures. In conclusion, different characteristics of RF time series signal possess promising features that can be used to characterize ablated and nonablated tissues and to distinguish them from each other in a quasi-quantitative fashion.

Dynamic and quasi-static mechanical testing for characterization of the viscoelastic properties of human uterine tissue

Ultrasound elastography is envisioned as an optional modality to augment standard ultrasound B-mode imaging and is a promising technique to aid in detecting uterine masses which cause abnormal uterine bleeding in both pre- and post-menopausal women. In order to determine the effectiveness of strain imaging, mechanical testing to establish the elastic contrast between normal uterine tissue and stiffer masses such as leiomyomas (fibroids) and between softer pathologies such as uterine cancer and adenomyosis has to be performed. In this paper, we evaluate the stiffness of normal uterine tissue, leiomyomas, and endometrial cancers using a EnduraTEC ElectroForce (ELF) system. We quantify the viscoelastic characteristics of uterine tissue and associated pathologies globally by using two mechanical testing approaches, namely a dynamic and a quasi-static (ramp testing) approach. For dynamic testing, 21 samples obtained from 18 patients were tested. The testing frequencies were set to 1, 10, 20, and 30 Hz. We also report on stiffness variations with pre-compression from 1% to 6% for testing at 2%, 3%, and 4% strain amplitude. Our results show that human uterine tissue stiffness is both dependent on percent pre-compression and testing frequencies. For ramp testing, 20 samples obtained from 14 patients were used. A constant strain rate of 0.1% was applied and comparable results to dynamic testing were obtained. The mean modulus contrast at 2% amplitude between normal uterine tissue (the background) and leiomyomas was 2.29 and 2.17, and between the background and cancer was 0.47 and 0.39 for dynamic and ramp testing, respectively.

Monitoring radiofrequency ablation using real-time ultrasound Nakagami imaging combined with frequency and temporal compounding techniques

Gas bubbles induced during the radiofrequency ablation (RFA) of tissues can affect the detection of ablation zones (necrosis zone or thermal lesion) during ultrasound elastography. To resolve this problem, our previous study proposed ultrasound Nakagami imaging for detecting thermal-induced bubble formation to evaluate ablation zones. To prepare for future applications, this study (i) created a novel algorithmic scheme based on the frequency and temporal compounding of Nakagami imaging for enhanced ablation zone visualization, (ii) integrated the proposed algorithm into a clinical scanner to develop a real-time Nakagami imaging system for monitoring RFA, and (iii) investigated the applicability of Nakagami imaging to various types of tissues. The performance of the real-time Nakagami imaging system in visualizing RFA-induced ablation zones was validated by measuring porcine liver (n = 18) and muscle tissues (n = 6). The experimental results showed that the proposed algorithm can operate on a standard clinical ultrasound scanner to monitor RFA in real time. The Nakagami imaging system effectively monitors RFA-induced ablation zones in liver tissues. However, because tissue properties differ, the system cannot visualize ablation zones in muscle fibers. In the future, real-time Nakagami imaging should be focused on the RFA of the liver and is suggested as an alternative monitoring tool when advanced elastography is unavailable or substantial bubbles exist in the ablation zone.

A survey of ultrasound elastography approaches to percutaneous ablation monitoring

Percutaneous thermal ablation has been widely used as a minimally invasive treatment for tumors. Treatment monitoring is essential for preventing complications while ensuring treatment efficacy. Mechanical testing measurements on tissue reveal that tissue stiffness increases with temperature and ablation duration. Different types of imaging methods can be used to monitor ablation procedures, including temperature or thermal strain imaging, strain imaging, modulus imaging, and shear modulus imaging. Ultrasound elastography demonstrates the potential to become the primary imaging modality for monitoring percutaneous ablation. This review briefly presented the state-of-the-art ultrasound elastography approaches for monitoring radiofrequency ablation and microwave ablation. These techniques were divided into four groups: quasi-static elastography, acoustic radiation force elastography, sonoelastography, and applicator motion elastography. Their advantages and limitations were compared and discussed. Future developments were proposed with respect to heat-induced bubbles, tissue inhomogeneities, respiratory motion, three-dimensional monitoring, multi-parametric monitoring, real-time monitoring, experimental data center for percutaneous ablation, and microwave ablation monitoring.

Derivation of the relationship between the rate of temperature rise and viscoelasticity for constructing a coagulation model for liver radio frequency ablation

Radio frequency ablation (RFA) is usually conducted using ultrasound (US) imaging to monitor the insertion procedure and the coagulation extent of liver tissue which is contiguous to the RFA electrode. However, when RFA surgery is started, the US image becomes unclear because of water vapor. This disadvantage of RFA can lead to excessive and insufficient RFA thereby diminishing the advantages of the procedure. In the present study, we proposed a simulation system which shows the progress status of coagulation for liver RFA. To derive the coagulation characteristics in liver RFA, we used the viscoelasticity of liver tissue as the coagulation indicator to investigate coagulation development for liver RFA. This paper shows the acquisition procedures for analyzing the relationship between the rate of temperature and viscoelasticity. We measured the complex modulus of porcine liver tissue under different rate of temperature in RFA by controlling the output power. We showed that the viscoelasticity of liver tissue depended on temperature previous temperature increase above 60°C. This result indicates that in RFA, controlling the output power is important to completely coagulate the tumor.

Visualizing ex vivo radiofrequency and microwave ablation zones using electrode vibration elastography

PURPOSE

Electrode vibration elastography is a new shear wave imaging technique that can be used to visualize thermal ablation zones. Prior work has shown the ability of electrode vibration elastography to delineate radiofrequency ablations; however, there has been no previous study of delineation of microwave ablations or radiological-pathological correlations using multiple observers.

METHODS

Radiofrequency and microwave ablations were formed in ex vivo bovine liver tissue. Their visualization was compared on shear wave velocity and maximum displacement images. Ablation dimensions were compared to gross pathology. Elastographic imaging and gross pathology overlap and interobserver variability were quantified using similarity measures.

RESULTS

Elastographic imaging correlated with gross pathology. Correlation of area estimates was better in radiofrequency than in microwave ablations, with Pearson coefficients of 0.79 and 0.54 on shear wave velocity images and 0.90 and 0.70 on maximum displacement images for radiofrequency and microwave ablations, respectively. The absolute relative difference in area between elastographic imaging and gross pathology was 18.9% and 22.9% on shear wave velocity images and 16.0% and 23.1% on maximum displacement images for radiofrequency and microwave ablations, respectively.

CONCLUSIONS

Statistically significant radiological-pathological correlation was observed in this study, but correlation coefficients were lower than other modulus imaging techniques, most notably in microwave ablations. Observers provided similar delineations for most thermal ablations. These results suggest that electrode vibration elastography is capable of imaging thermal ablations, but refinement of the technique may be necessary before it can be used to monitor thermal ablation procedures clinically.

Characterizing the compression-dependent viscoelastic properties of human hepatic pathologies using dynamic compression testing

Recent advances in elastography have provided several imaging modalities capable of quantifying the elasticity of tissue, an intrinsic tissue property. This information is useful for determining tumour margins and may also be useful for diagnosing specific tumour types. In this study, we used dynamic compression testing to quantify the viscoelastic properties of 16 human hepatic primary and secondary malignancies and their corresponding background tissue obtained following surgical resection. Two additional backgrounds were also tested. An analysis of the background tissue showed that F4-graded fibrotic liver tissue was significantly stiffer than F0-graded tissue, with a modulus contrast of 4:1. Steatotic liver tissue was slightly stiffer than normal liver tissue, but not significantly so. The tumour-to-background storage modulus contrast of hepatocellular carcinomas, a primary tumour, was approximately 1:1, and the contrast decreased with increasing fibrosis grade of the background tissue. Ramp testing showed that the background stiffness increased faster than the malignant tissue. Conversely, secondary tumours were typically much stiffer than the surrounding background, with a tumour-to-background contrast of 10:1 for colon metastases and 10:1 for cholangiocarcinomas. Ramp testing showed that colon metastases stiffened faster than their corresponding backgrounds. These data have provided insights into the mechanical properties of specific tumour types, which may prove beneficial as the use of quantitative stiffness imaging increases.

A method for deriving the coagulation boundary of liver tissue using a relational model of viscoelasticity and temperature in radio frequency ablation

Recently radiofrequency (RF) ablation has become increasingly important in treating liver cancers. RF ablation is ordinarily conducted using elastographic imaging to monitor the ablation procedure and the temperature of the electrode needle is displayed on the RF generator. However, the coagulation boundary of liver tissue in RF ablation is unclear and unconfident. This can lead to both excessive and insufficient RF ablation thereby diminishing the advantages of the procedure. In the present study, we developed a method for determining the coagulation boundary of liver tissue in RF ablation. To investigate this boundary we used the mechanical characteristics of biochemical components as an indicator of coagulation to produce a relational model for viscoelasticity and temperature. This paper presents the data acquisition procedures for the viscoelasticity characteristics and the analytical method used for the coagulation model. We employed a rheometer to measure the viscoelastic characteristics of liver tissue. To determine the model functional relationship between viscoelasticity and temperature, we used a least-square method and the minimum root mean square error was calculated to optimize the model functional relations. The functional relation between temperature and viscoelasticity was linear and non-linear in different temperature regions. The boundary between linear and non-linear functional relation was 58.0°C.