Forward problem study of an effective medium model for ultrasound blood characterization

Extracting Quantitative Ultrasonic Parameters from the Backscatter Coefficient

The ultrasonic backscatter coefficient (BSC) is a fundamental quantitative ultrasound (QUS) parameter that contains rich information about the underlying tissue. Deriving parameters from the BSC is essential for fully utilizing the information contained in BSC for tissue characterization. In this chapter, we review two primary approaches for extracting parameters from the BSC versus frequency curve: the model-based approach and the model-free approach, focusing on the model-based approach, where a scattering model is fit to the observed BSC to yield model parameters. For this approach, we will attempt to unite commonly used models under a coherent theoretical framework. We will focus on the underlying assumptions and conditions for various BSC models. Computer code is provided to facilitate the use of some of the models. The strengths and weaknesses of various models are also discussed.

Numerical investigations of anisotropic structures of red blood cell aggregates on ultrasonic backscattering

Although quantitative ultrasound techniques based on the parameterization of the backscatter coefficient (BSC) have been successfully applied to blood characterization, theoretical scattering models assume blood as an isotropic scattering medium. However, the red blood cell (RBC) aggregates form anisotropic structures such as rouleaux. The present study proposes an anisotropic formulation of the effective medium theory combined with the local monodisperse approximation (EMTLMA) that considers perfectly aligned prolate-shaped aggregates. Theoretical BSC predictions were first compared with computer simulations of BSCs in a forward problem framework. Computer simulations were conducted for perfectly aligned prolate-shaped aggregates and more complex configurations with partially aligned prolate-shaped aggregates for which the size and orientation of RBC aggregates were obtained from blood optical observations. The isotropic and anisotropic EMTLMA models were then compared in an inverse problem framework to estimate blindly the structural parameters of RBC aggregates from the simulated BSCs. When considering the isotropic EMTLMA, the use of averaged BSCs over different insonification directions significantly improves the estimation of aggregate structural parameters. Overall, the anisotropic EMTLMA was found to be superior to the isotropic EMTLMA in estimating the scatterer volume distribution. These results contribute to a better interpretation of scatterer size estimates for blood characterization.

Quantifying scattering from dense media using two-dimensional impedance maps

A better understanding of ultrasound scattering in a three-dimensional (3D) medium can provide more accurate methods for ultrasound tissue characterization. The possibility of using two-dimensional impedance maps (2DZMs) based on correlation coefficients has shown promise in the case of isotropic and sparse medium [Luchies and Oelze, J. Acoust. Soc. Am. 139, 1557-1564 (2016)]. The present study investigates the use of 2DZMs in order to quantify 3D scatterer properties of dense media from two-dimensional (2D) histological slices. Two 2DZM approaches were studied: one based on the correlation coefficient and the other based on the 2D Fourier transform of 2DZMs. Both 2DZM approaches consist in estimating the backscatter coefficient (BSC) from several 2DZMs, and then the resulting BSC was fit to the theoretical polydisperse structure factor model to yield 3D scatterer properties. Simulation studies were performed to evaluate the ability of both 2DZM approaches to quantify scattering of a 3D medium containing randomly distributed polydisperse spheres or monodisperse ellipsoids. Experimental studies were also performed using the histology photomicrographs obtained from HT29 cell pellet phantoms. Results demonstrate that the 2DZM Fourier transform-based approach was more suitable than the correlation coefficient-based approach for estimating scatterer properties when using a small number of 2DZMs.

Quantitative ultrasound imaging of cell-laden hydrogels and printed constructs

In the present work we have revisited the application of quantitative ultrasound imaging (QUI) to cellular hydrogels, by using the reference phantom method (RPM) in combination with a local attenuation compensation algorithm. The investigated biological samples consisted of cell-laden collagen hydrogels with PC12 neural cells. These cell-laden hydrogels were used to calibrate the integrated backscattering coefficient (IBC) as a function of cell density, which was then used to generate parametric images of local cell density. The image resolution used for QUI and its impact on the relative IBC error was also investigated. Another important contribution of our work was the monitoring of PC12 cell proliferation. The cell number estimates obtained via the calibrated IBC compared well with data obtained using a conventional quantitative method, the MTS assay. Evaluation of spectral changes as a function of culture time also provided additional information on the cell cluster size, which was found to be in close agreement with that observed by microscopy. Last but not least, we also applied QUI on a 3D printed cellular construct in order to illustrate its capabilities for the evaluation of bioprinted structures. STATEMENT OF SIGNIFICANCE: While there is intensive research in the areas of polymer science, biology, and 3D bio-printing, there exists a gap in available characterisation tools for the non-destructive inspection of biological constructs in the three-dimensional domain, on the macroscopic scale, and with fast data acquisition times. Quantitative ultrasound imaging is a suitable characterization technique for providing essential information on the development of tissue engineered constructs. These results provide a detailed and comprehensive guide on the capabilities and limitations of the technique.

Quantitative Measurement of Erythrocyte Aggregation as a Systemic Inflammatory Marker by Ultrasound Imaging: A Systematic Review

This systematic review is aimed at answering two questions: (i) Is erythrocyte aggregation a useful biomarker in assessing systemic inflammation? (ii) Does quantitative ultrasound imaging provide the non-invasive option to measure erythrocyte aggregation in real time? The search was executed through bibliographic electronic databases CINAHL, EMB Review, EMBASE, MEDLINE, PubMed and the grey literature. The majority of studies correlated elevated erythrocyte aggregation with inflammatory blood markers for several pathologic states. Some studies used "erythrocyte aggregation" as an established marker of systemic inflammation. There were limited but promising articles regarding the use of quantitative ultrasound spectroscopy to monitor erythrocyte aggregation. Similarly, there were limited studies that used other ultrasound techniques to measure systemic inflammation. The quantitative measurement of erythrocyte aggregation has the potential to be a routine clinical marker of inflammation as it can reflect the cumulative inflammatory dynamics in vivo, is relatively simple to measure, is cost-effective and has a rapid turnaround time. Technologies like quantitative ultrasound spectroscopy that can measure erythrocyte aggregation non-invasively and in real time may offer the advantage of continuous monitoring of the inflammation state and, thus, may help in rapid decision making in a critical care setup.

Estimation of polydispersity in aggregating red blood cells by quantitative ultrasound backscatter analysis

Quantitative ultrasound techniques based on the backscatter coefficient (BSC) have been commonly used to characterize red blood cell (RBC) aggregation. Specifically, a scattering model is fitted to measured BSC and estimated parameters can provide a meaningful description of the RBC aggregates' structure (i.e., aggregate size and compactness). In most cases, scattering models assumed monodisperse RBC aggregates. This study proposes the Effective Medium Theory combined with the polydisperse Structure Factor Model (EMTSFM) to incorporate the polydispersity of aggregate size. From the measured BSC, this model allows estimating three structural parameters: the mean radius of the aggregate size distribution, the width of the distribution, and the compactness of the aggregates. Two successive experiments were conducted: a first experiment on blood sheared in a Couette flow device coupled with an ultrasonic probe, and a second experiment, on the same blood sample, sheared in a plane-plane rheometer coupled to a light microscope. Results demonstrated that the polydisperse EMTSFM provided the best fit to the BSC data when compared to the classical monodisperse models for the higher levels of aggregation at hematocrits between 10% and 40%. Fitting the polydisperse model yielded aggregate size distributions that were consistent with direct light microscope observations at low hematocrits.

Effects of the container on structure function with impedance map analysis of dense scattering media

Quantitative ultrasound (QUS) can be used to estimate acoustic properties of tissue microstructure. In one approach to QUS, the backscatter coefficient (BSC) is utilized to quantify and classify tissue state. From the BSC, parametric models can be constructed to relate the frequency-dependent BSC to geometrical properties of the underlying tissue. However, most of these parametric models are based on analytic expressions (e.g., Gaussian function) and not on actual tissue morphology. Impedance map analysis has been proposed to help identify sources of ultrasonic scattering in tissues and to develop improved models of scattering. Previously, two-dimensional impedance maps (2DZMs) were demonstrated to provide tissue models of three-dimensional (3D) structures for sparse scattering media. In the current study, 2DZMs analysis of dense scatterer media combining the structure function with impedance map analysis was studied through a series of simulations. The simulation analysis demonstrated that the correlation coefficient and power spectrum could be estimated for a dense collection of spheres using 2DZMs. The current finding implies that 2DZMs can capture information about the 3D spatial positions of scatterers in addition to information about the size and shape of the scatterers for a dense scattering media, which is expected to be encountered in many tissues.

Protocol for Robust In Vivo Measurements of Erythrocyte Aggregation Using Ultrasound Spectroscopy

Erythrocyte aggregation is a non-specific marker of acute and chronic inflammation. Although it is usual to evaluate this phenomenon from blood samples analyzed in laboratory instruments, in vivo real-time assessment of aggregation is possible with spectral ultrasound techniques. However, variable blood flow can affect the interpretation of acoustic measures. Therefore, flow standardization is required. Two techniques of flow standardization were evaluated with porcine and equine blood samples in Couette flow. These techniques consisted in either stopping the flow or reducing it. Then, the sensibility and repeatability of the retained method were evaluated in 11 human volunteers. We observed that stopping the flow compromised interpretation and repeatability. Conversely, maintaining a low flow provided repeatable measures and could distinguish between normal and high extents of erythrocyte aggregation. Agreement was observed between in vivo and ex vivo measures of the phenomenon (R² = 82.7%, p value < 0.0001). These results support the feasibility of assessing in vivo erythrocyte aggregation in humans by quantitative ultrasound means.

Coherent and incoherent ultrasound backscatter from cell aggregates

The effective medium theory (EMT) was recently developed to model the ultrasound backscatter from aggregating red blood cells [Franceschini, Metzger, and Cloutier, IEEE Trans. Ultrason. Ferroelectr. Freq. Control 58, 2668-2679 (2011)]. The EMT assumes that aggregates can be treated as homogeneous effective scatterers, which have effective properties determined by the aggregate compactness and the acoustical characteristics of the cells and the surrounding medium. In this study, the EMT is further developed to decompose the differential backscattering cross section of a single cell aggregate into coherent and incoherent components. The coherent component corresponds to the squared norm of the average scattering amplitude from the effective scatterer, and the incoherent component considers the variance of the scattering amplitude (i.e., the mean squared norm of the fluctuation of the scattering amplitude around its mean) within the effective scatterer. A theoretical expression for the incoherent component based on the structure factor is proposed and compared with another formulation based on the Gaussian direct correlation function. This theoretical improvement is assessed using computer simulations of ultrasound backscatter from aggregating cells. The consideration of the incoherent component based on the structure factor allows us to approximate the simulations satisfactorily for a product of the wavenumber times the aggregate radius kr_ag around 2.

Multidimensional spectral analysis of the ultrasonic radiofrequency signal for characterization of media

The importance of the analysis of the radiofrequency signal is by now recognized in the field of tissue characterization via ultrasound. The RF signal contains a wealth of information and structural details that are usually lost in the B-Mode representation. The HyperSPACE (Hyper SPectral Analysis for Characterization in Echography) algorithm presented by the authors in previous papers for clinical applications is based on the radiofrequency ultrasonic signal. The present work describes the method in detail and evaluates its performance in a repeatable and standardized manner, by using two test objects: a commercial test object that simulates the human parenchyma, and a laboratory-made test object consisting of human blood at different dilution values. In particular, the sensitivity and specificity in discriminating different density levels were estimated. In addition, the robustness of the algorithm with respect to the signal-to-noise ratio was also evaluated.

Retrieval of the equivalent acoustic constitutive parameters of an inhomogeneous fluid-like object by nonlinear full waveform inversion

This study addresses the problem of the acoustic characterization of an inhomogeneous object such as a soft-tissue organ containing a cyst or tumor whose size and/or composition evolve either negatively due to increased disease or positively due to increased response to treatment. The so-called 'corrupted' binary object, probed by a transient, acoustic plane wave, is a tube composed of a homogenous fluid-like (or assumed as such) mantle (medium 1: three acoustic constitutive parameters, one geometric parameter) surrounding a homogeneous fluid-like (or assumed as such) core (medium 2: three acoustic constitutive parameters, one geometric parameter), immersed in a spatially-infinite, homogeneous fluid (host medium 0: two acoustic parameters). The complete inversion of the diffracted acoustic field response of this object involves the retrieval of seven (six acoustic and one geometric) parameters, assuming we know beforehand the outer radius of the tube and acoustic parameters of the host. An alternative to this time-consuming, hazardous (due to the ill-posed nature of the) procedure, is to minimize the discrepancy, between the full waveform response of the binary object to a transient plane wave and the response of a homogeneous cylinder (medium characterized by three acoustic parameters, one geometric parameter) to the same transient plane wave, so as to retrieve the (three so-called equivalent) acoustic parameters of the homogeneous object. Thus, the first inverse problem is replaced by a second one (same assumptions concerning the outer radius of the objects, the host medium, the probe radiation and the sensing configuration as the first one) involving the retrieval of only three (instead of six) acoustic parameters. This procedure is potentially useful if the variation of at least one of the three equivalent parameters is sensitive to the variation of a key parameter of the inhomogeneous body (usually the characteristic dimension or the wavespeed of the core) and this variation can be expressed in a simple algebraic form (such as by a mixing formula). It is shown that this situation can arise if the average frequency of the acoustic probe radiation is sufficiently low. A sidelight of this investigation is the discovery that the equivalent constitutive parameters of the homogeneous cylinder are dispersive even when the component materials of the tube are not dispersive.

Review of Quantitative Ultrasound: Envelope Statistics and Backscatter Coefficient Imaging and Contributions to Diagnostic Ultrasound

Conventional medical imaging technologies, including ultrasound, have continued to improve over the years. For example, in oncology, medical imaging is characterized by high sensitivity, i.e., the ability to detect anomalous tissue features, but the ability to classify these tissue features from images often lacks specificity. As a result, a large number of biopsies of tissues with suspicious image findings are performed each year with a vast majority of these biopsies resulting in a negative finding. To improve specificity of cancer imaging, quantitative imaging techniques can play an important role. Conventional ultrasound B-mode imaging is mainly qualitative in nature. However, quantitative ultrasound (QUS) imaging can provide specific numbers related to tissue features that can increase the specificity of image findings leading to improvements in diagnostic ultrasound. QUS imaging can encompass a wide variety of techniques including spectral-based parameterization, elastography, shear wave imaging, flow estimation, and envelope statistics. Currently, spectral-based parameterization and envelope statistics are not available on most conventional clinical ultrasound machines. However, in recent years, QUS techniques involving spectral-based parameterization and envelope statistics have demonstrated success in many applications, providing additional diagnostic capabilities. Spectral-based techniques include the estimation of the backscatter coefficient (BSC), estimation of attenuation, and estimation of scatterer properties such as the correlation length associated with an effective scatterer diameter (ESD) and the effective acoustic concentration (EAC) of scatterers. Envelope statistics include the estimation of the number density of scatterers and quantification of coherent to incoherent signals produced from the tissue. Challenges for clinical application include correctly accounting for attenuation effects and transmission losses and implementation of QUS on clinical devices. Successful clinical and preclinical applications demonstrating the ability of QUS to improve medical diagnostics include characterization of the myocardium during the cardiac cycle, cancer detection, classification of solid tumors and lymph nodes, detection and quantification of fatty liver disease, and monitoring and assessment of therapy.

Unifying Concepts of Statistical and Spectral Quantitative Ultrasound Techniques

Quantitative ultrasound (QUS) techniques using radiofrequency (RF) backscattered signals have been used for tissue characterization of numerous organ systems. One approach is to use the magnitude and frequency dependence of backscatter echoes to quantify tissue structures. Another approach is to use first-order statistical properties of the echo envelope as a signature of the tissue microstructure. We propose a unification of these QUS concepts. For this purpose, a mixture of homodyned K-distributions is introduced to model the echo envelope, together with an estimation method and a physical interpretation of its parameters based on the echo signal spectrum. In particular, the total, coherent and diffuse signal powers related to the proposed mixture model are expressed explicitly in terms of the structure factor previously studied to describe the backscatter coefficient (BSC). Then, this approach is illustrated in the context of red blood cell (RBC) aggregation. It is experimentally shown that the total, coherent and diffuse signal powers are determined by a structural parameter of the spectral Structure Factor Size and Attenuation Estimator. A two-way repeated measures ANOVA test showed that attenuation (p-value of 0.077) and attenuation compensation (p-value of 0.527) had no significant effect on the diffuse to total power ratio. These results constitute a further step in understanding the physical meaning of first-order statistics of ultrasound images and their relations to QUS techniques. The proposed unifying concepts should be applicable to other biological tissues than blood considering that the structure factor can theoretically model any spatial distribution of scatterers.

Experimental application of ultrafast imaging to spectral tissue characterization

Ultrasound ultrafast imaging (UI) allows acquisition of thousands of frames per second with a sustained image quality at any depth in the field of view. Therefore, it would be ideally suited to obtain good statistical sampling of fast-moving tissues using spectral-based techniques to derive the backscatter coefficient (BSC) and associated quantitative parameters. In UI, an image is formed by insonifying the medium with plane waves steered at different angles, beamforming them and compounding the resulting radiofrequency images. We aimed at validating, experimentally, the effect of these beamforming protocols on the BSC, under both isotropic and anisotropic conditions. Using UI techniques with a linear array transducer (5-14 MHz), we estimated the BSCs of tissue-mimicking phantoms and flowing porcine blood at depths up to 35 mm with a frame rate reaching 514 Hz. UI-based data were compared with those obtained using single-element transducers and conventional focusing imaging. Results revealed that UI compounded images can produce valid estimates of BSCs and effective scatterer size (errors less than 2.2 ± 0.8 and 0.26 ± 0.2 dB for blood and phantom experiments, respectively). This work also describes the use of pre-compounded UI images (i.e., steered images) to assess the angular dependency of circulating red blood cells. We have concluded that UI data sets can be used for BSC spectral tissue analysis and anisotropy characterization.

Structure factor model for understanding the measured backscatter coefficients from concentrated cell pellet biophantoms

Ultrasonic backscatter coefficient (BSC) measurements were performed on K562 cell pellet biophantoms with cell concentrations ranging from 0.006 to 0.30 in the 10-42 MHz frequency bandwidth. Three scattering models, namely, the fluid-filled sphere model (FFSM), the particle model (PM), and the structure factor model (SFM), were compared for modeling the scattering from an ensemble of concentrated cells. A parameter estimation procedure was developed in order to estimate the scatterer size and relative impedance contrast that could explain the measured BSCs from all the studied cell concentrations. This procedure was applied to the BSC data from K562 cell pellet biophantoms in the 10-42 MHz frequency bandwidth and to the BSC data from Chinese hamster ovary cell pellet biophantoms in the 26-105 MHz frequency bandwidth given in Han, Abuhabsah, Blue, Sarwate, and O'Brien [J. Acoust. Soc. Am. 130, 4139-4147 (2011)]. The data fitting quality and the scatterer size estimates show that the SFM was more suitable than the PM and the FFSM for modeling the responses from concentrated cell pellet biophantoms.

Comparison of three scattering models for ultrasound blood characterization

Ultrasonic backscattered signals from blood contain frequency-dependent information that can be used to obtain quantitative parameters reflecting the aggregation level of red blood cells (RBCs). The approach is based on estimating structural aggregate parameters by fitting the spectrum of the backscattered radio-frequency echoes from blood to an estimated spectrum considering a theoretical scattering model. In this study, three scattering models were examined: a new implementation of the Gaussian model (GM), the structure factor size estimator (SFSE), and the new effective medium theory combined with the structure factor model (EMTSFM). The accuracy of the three scattering models in determining mean aggregate size and compactness was compared by 2-D and 3-D computer simulations in which RBC structural parameters were controlled. Two clustering conditions were studied: 1) the aggregate size varied and the aggregate compactness was fixed in both 2-D and 3-D cases, and 2) the aggregate size was fixed and the aggregate compactness varied in the 2-D case. For both clustering conditions, the EMTSFM was found to be more suitable than GM and SFSE for characterizing RBC aggregation.

Experimental assessment of four ultrasound scattering models for characterizing concentrated tissue-mimicking phantoms

Tissue-mimicking phantoms with high scatterer concentrations were examined using quantitative ultrasound techniques based on four scattering models: The Gaussian model (GM), the Faran model (FM), the structure factor model (SFM), and the particle model (PM). Experiments were conducted using 10- and 17.5-MHz focused transducers on tissue-mimicking phantoms with scatterer concentrations ranging from 1% to 25%. Theoretical backscatter coefficients (BSCs) were first compared with the experimentally measured BSCs in the forward problem framework. The measured BSC versus scatterer concentration relationship was predicted satisfactorily by the SFM and the PM. The FM and the PM overestimated the BSC magnitude at actual concentrations greater than 2.5% and 10%, respectively. The SFM was the model that better matched the BSC magnitude at all the scatterer concentrations tested. Second, the four scattering models were compared in the inverse problem framework to estimate the scatterer size and concentration from the experimentally measured BSCs. The FM did not predict the concentration accurately at actual concentrations greater than 12.5%. The SFM and PM need to be associated with another quantitative parameter to differentiate between low and high concentrations. In that case, the SFM predicted the concentration satisfactorily with relative errors below 38% at actual concentrations ranging from 10% to 25%.

Quantitative ultrasound estimates from populations of scatterers with continuous size distributions: effects of the size estimator algorithm

Quantitative ultrasonic techniques using backscatter coefficients (BSCs) may fail to produce physically meaningful estimates of effective scatterer diameter (ESD) when the analysis media contains scatterers of different sizes. In this work, three different estimator algorithms were used to produce estimates of ESD. The performance of the three estimators was compared over different frequency bands using simulations and experiments with physical phantoms. All estimators produced ESD estimates by comparing the estimated BSCs with a scattering model based on the backscattering cross section of a single spherical fluid scatterer. The first estimator consisted of minimizing the average square deviation of the logarithmically compressed ratio between the estimated BSCs and the scattering model. The second and third estimators consisted of minimizing the mean square error between the estimated BSCs and a linear transformation of the scattering model with and without considering an intercept, respectively. Simulations were conducted over several analysis bandwidths between 1 and 40 MHz from populations of scatterers with either a uniform size distribution or a distribution based on the inverse cubic of the size. Diameters of the distributions ranged between [25, 100], [25, 50], [50, 100], and [50, 75] μm. Experimental results were obtained from two gelatin phantoms containing cross-linked dextran gel spheres ranging in diameter from 28 to 130 μm and 70 to 130 μm, respectively, and 5-, 7.5-, 10-, and 13-MHz focused transducers. Significant differences in the performances of the ESD estimator algorithms as a function of the analysis frequency were observed. Specifically, the third estimator exhibited potential to produce physically meaningful ESD estimates even for large ka values when using a single-size scattering model if sufficient analysis bandwidth was available.