Maximum likelihood estimation of shear wave speed in transient elastography

Palm-Sized Wireless Transient Elastography System with Real-Time B-Mode Ultrasound Imaging Guidance: Toward Point-of-Care Liver Fibrosis Assessment

Transient elastography (TE), recommended by the WHO, is an established method for characterizing liver fibrosis via liver stiffness measurement (LSM). However, technical barriers remain towards point-of-care application, as conventional TE requires wired connections, possesses a bulky size, and lacks adequate imaging guidance for precise liver localization. In this work, we report the design, phantom validation, and clinical evaluation of a palm-sized TE system that enables simultaneous B-mode imaging and LSM. The performance of this system was validated experimentally using tissue-equivalent reference phantoms (1.45-75 kPa). Comparative studies against other liver elastography techniques, including conventional TE and two-dimensional shear wave elastography (2D-SWE), were performed to evaluate its reliability and validity in adults with various chronic liver diseases. Intra- and inter-operator reliability of LSM were established by an elastography expert and a novice. A good agreement was observed between the Young's modulus reported by the phantom manufacturer and this system (bias: 1.1-8.6%). Among 121 patients, liver stiffness measured by this system and conventional TE were highly correlated (r = 0.975) and strongly agreed with each other (mean difference: -0.77 kPa). Inter-correlation of this system with conventional TE and 2D-SWE was observed. Excellent-to-good operator reliability was demonstrated in 60 patients (ICCs: 0.824-0.913). We demonstrated the feasibility of employing a fully integrated phased array probe for reliable and valid LSM, guided by real-time B-mode imaging of liver anatomy. This system represents the first technical advancement toward point-of-care liver fibrosis assessment. Its small footprint, along with B-mode guidance capability, improves examination efficiency and scales up screening for liver fibrosis.

Image reconstruction utilizing median filtering applied to elastography

BACKGROUND

The resources of ultrafast technology can be used to add another analysis to ultrasound imaging: assessment of tissue viscoelasticity. Ultrafast image formation can be utilized to find transitory shear waves propagating in soft tissue, which permits quantification of the mechanical properties of the tissue via elastography. This technique permits simple and noninvasive diagnosis and monitoring of disease.

METHODS

This article presents a method to estimate the viscoelastic properties and rigidity of structures using the ultrasound technique known as shear wave elasticity imaging (SWEI). The Verasonics Vantage 128 research platform and L11-4v transducer were used to acquire radio frequency signals from a model 049A elastography phantom (CIRS, USA), with subsequent processing and analysis in MATLAB.

RESULTS

The images and indexes obtained reflect the qualitative measurements of the different regions of inclusions in the phantom and the respective alterations in the viscoelastic properties of distinct areas. Comparison of the results obtained with this proposed technique and other commonly used techniques demonstrates the characteristics of median filtering in smoothing variations in velocity to form elastographic images. The results from the technique proposed in this study are within the margins of error indicated by the phantom manufacturer for each type of inclusion; for the phantom base and for type I, II, III, and IV inclusions, respectively, in kPa and percentage errors, these are 25 (24.0%), 8 (37.5%), 14 (28.6%), 45 (17.8%), and 80 (15.0%). The values obtained using the method proposed in this study and mean percentage errors were 29.18 (- 16.7%), 10.26 (- 28.2%), 15.64 (- 11.7%), 45.81 (- 1.8%), and 85.21 (- 6.5%), respectively.

CONCLUSIONS

The new technique to obtain images uses a distinct filtering function which considers the mean velocity in the region around each pixel, in turn allowing adjustments according to the characteristics of the phantom inclusions within the ultrasound and optimizing the resulting elastographic images.

Plane-Wave Imaging Improves Single-Track Location Shear Wave Elasticity Imaging

Single-track location shear wave elasticity imaging (STL-SWEI) is immune to speckle bias, but the quality of the images is depth dependent. We hypothesize that plane-wave imaging can reduce the depth dependence of STL-SWEI. To test this hypothesis, we developed a novel technique known as plane-wave STL-SWEI (pSTL-SWEI). To evaluate the pSTL-SWEI's potential, we performed studies on phantoms and excised murine pancreatic tumors. The mean shear wave speeds measured with STL-SWEI and pSTL-SWEI were similar. However, the elastographic signal-to-noise ratio (SNR_e) of pSTL-SWEI elastograms was noticeably higher than that produced with STL-SWEI. Specifically, we observed an improvement in SNR_e ranging from 39.9%-55.1%, depending on tissue stiffness. The spatial resolution of pSTL-SWEI elastograms was 2.7%-12.1% lower than that produced with STL-SWEI. pSTL-SWEI elastograms displayed higher contrast-to-noise ratio (CNR_e) than those produced with STL-SWEI, especially when imaging was performed with low push pulse intensities and low pulse durations.

A Novel FibroScan Examination Dedicated to Spleen Stiffness Measurement

Esophageal varices (EVs) are among the most severe complications of cirrhosis, with a prevalence of 50% to 60% among cirrhotic patients. International guidelines therefore recommend that cirrhotic patients should be screened for the presence of EVs. The main objective of this study was to introduce a new spleen-dedicated FibroScan (Echosens, Paris, France) examination and to assess its performance in detecting large EVs (grade 2 and 3). This novel examination has been validated in simulation and phantom studies and has been used in a population of patients with chronic liver disease. The study described here suggests that the novel spleen-dedicated FibroScan examination performs better than the standard FibroScan for the detection of large EVs (area under the curve = 0.70 for the standard examination and 0.79 [p <0.01] for the spleen examination), but further clinical studies are needed to investigate the role of spleen stiffness in the management of cirrhotic patients.

DDEFL1 correlated with Rho GTPases activity in breast cancer

DDEFL1 is related to maintaining a limiting amount of ARF6 in GTP-loaded form by accelerating its GTP hydrolysis activity, which has been implicated in hepatocellular cancer pathogenesis and lung cancer development. We investigated DDEFL1 expression in breast cancer and paired normal breast tissues by immunohistochemistry and found that DDEFL1 expression was significantly associated with tumor size, lymph node metastasis, high content of elastosis and TNM stage but not with menopausal status or age. We detected the mRNA and protein expression of DDEFL1 in breast cancer cell lines by Western blotting and quantitative real-time PCR (qRT-PCR). DDEFL1 was obvious in MDA-MB-435s and MDA-MB-231 but very weak in ZR-75-1. Further experiments were conducted to evaluate the effect of DDEFL1 small interfering RNA (siRNA) transfection on the biological behavior of MDA-MB-231. After transfection, the effects of DDEFL1 inhibition on expression of mRNA and protein were also analyzed by Western blotting and qRT-PCR. Increased apoptosis and invasive ability, decreased cellular proliferation was found in MDA-MB-231 with successful DDEFL1 siRNA transient transfection (p < 0.05). Western blotting and qRT-PCR results showed that the DDEFL1 inhibition up-regulated Caspase-3, Apaf-1, cytochrome c, and Bax expression and down-regulated Bcl-2 expression. The DDEFL1 inhibition also down-regulated the mRNA and protein expression of Rho, CDC42 and Rac1. Our study provided a functional linkage through DDEFL1 with breast cancer biological behaviours by Rho GTPases. Possible implication of our main finding for the DDEFL1 role in breast cancer and the downstream signaling pathways for the treatment of breast cancer.

AdipoScan: A Novel Transient Elastography-Based Tool Used to Non-Invasively Assess Subcutaneous Adipose Tissue Shear Wave Speed in Obesity

We describe a novel device called the AdipoScan that was adapted from the FibroScan to specifically assess shear wave speed (SWS) in human abdominal subcutaneous adipose tissue (scAT). Measurement reproducibility was assessed on tissue-mimicking phantoms with and without repositioning, with resultant coefficients of variation of 1% and 0%, respectively, as well as in vivo (14% and 7%, respectively). The applicability of the AdipoScan was tested on 19 non-obese volunteers, and a scAT thickness >2 cm was found to be mandatory to perform a valid measurement. Abdominal scAT SWS was assessed in 73 severely obese subjects, all candidates for bariatric surgery. Subcutaneous AT SWS was positively associated with scAT fibrosis and obesity-related co-morbidities such as hypertension, glycemic status, dyslipidemia and liver dysfunction. These results suggest that the AdipoScan could be a useful non-invasive tool to evaluate scAT fibrosis and metabolic complications in obesity. Further investigation is required to evaluate the relevance of using the AdipoScan to predict patient weight trajectories and metabolic outcomes after bariatric surgery.

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 1, Principles and Techniques

OBJECTIVE

The purpose of this article is to provide an overview of ultrasound and MR elastography, including a glossary of relevant terminology, a classification of elastography techniques, and a discussion of their respective strengths and limitations.

CONCLUSION

Elastography is an emerging technique for the noninvasive assessment of mechanical tissue properties. These techniques report metrics related to tissue stiffness, such as shear-wave speed, magnitude of the complex shear modulus, and the Young modulus.