Shear wave speed recovery using moving interference patterns obtained in sonoelastography experiments

An Inverse Eikonal Method for Identifying Ventricular Activation Sequences from Epicardial Activation Maps

A key mechanism controlling cardiac function is the electrical activation sequence of the heart's main pumping chambers termed the ventricles. As such, personalization of the ventricular activation sequences is of pivotal importance for the clinical utility of computational models of cardiac electrophysiology. However, a direct observation of the activation sequence throughout the ventricular volume is virtually impossible. In this study, we report on a novel method for identification of activation sequences from activation maps measured at the outer surface of the heart termed the epicardium. Conceptually, the method attempts to identify the key factors governing the ventricular activation sequence - the timing of earliest activation sites (EAS) and the velocity tensor field within the ventricular walls - from sparse and noisy activation maps sampled from the epicardial surface and fits an Eikonal model to the observations. Regularization methods are first investigated to overcome the severe ill-posedness of the inverse problem in a simplified 2D example. These methods are then employed in an anatomically accurate biventricular model with two realistic activation models of varying complexity - a simplified trifascicular model (3F) and a topologically realistic model of the His-Purkinje system (HPS). Using epicardial activation maps at full resolution, we first demonstrate that reconstructing the volumetric activation sequence is, in principle, feasible under the assumption of known location of EAS and later evaluate robustness of the method against noise and reduced spatial resolution of observations. Our results suggest that the FIMIN algorithm is able to robustly recover the full 3D activation sequence using epicardial activation maps at a spatial resolution achievable with current mapping systems and in the presence of noise. Comparing the accuracy achieved in the reconstructed activation maps with clinical data uncertainties suggests that the FIMIN method may be suitable for the patient- specific parameterization of activation models.

Shear wave estimation by using Shear Wave Holography with normal vibration: Preliminary results

Mechanical properties of soft human tissue are linked to their pathological state. One way to assess these properties is through the Young modulus measurement, which is related to the shear wave speed in the medium when considering tissues as nearly incompressible. In order to characterize its elastic properties using sonoelastography, we introduce a new technique for shear wave estimation from a static interference pattern based on Shear Wave Holography. A relation between the mathematical representation of the interference pattern and the local shear speed is derived using the Phase Derivative approach. The experimental scheme is presented, detailing the advantages of the new configuration. Homogeneous and heterogeneous elastic media were simulated, generating an interference pattern on them. The shear speed estimation algorithm was explained and applied to obtain the speed map, calculating the mean value over each medium. The technique was tested on a nearly incompressible homogeneous elastic phantom, yielding a maximum and a mean estimation error of 6% and 4.6% respectively. Overall, Shear Wave Holography using normal vibration is feasible and shows promising results in estimating shear wave speed in elastic materials.

Integration of crawling waves in an ultrasound imaging system. Part 1: system and design considerations

An ultrasound system (GE Logiq 9) was modified to produce a synthetic crawling wave using shear wave displacements generated by the radiation force of focused beams formed at the left and the right edge of the region of interest (ROI). Two types of focusing, normal and axicon, were implemented. Baseband (IQ) data was collected to determine the left and right displacements, which were then used to calculate an interference pattern. By imposing a variable delay between the two pushes, the interference pattern moves across the ROI to produce crawling waves. Also temperature and pressure measurements were made to assess the safety issues. The temperature profiles measured in a veal liver along the focal line showed the maximum temperature rise less than 0.8°C, and the pressure measurements obtained in degassed water and derated by 0.3 dB/cm/MHz demonstrate that the system can operate within FDA safety guidelines.

Shear wave dispersion measures liver steatosis

Crawling waves, which are interfering shear wave patterns, can be generated in liver tissue over a range of frequencies. Some important biomechanical properties of the liver can be determined by imaging the crawling waves using Doppler techniques and analyzing the patterns. We report that the dispersion of shear wave velocity and attenuation, that is, the frequency dependence of these parameters, are strongly correlated with the degree of steatosis in a mouse liver model, ex vivo. The results demonstrate the possibility of assessing liver steatosis using noninvasive imaging methods that are compatible with color Doppler scanners and, furthermore, suggest that liver steatosis can be separated from fibrosis by assessing the dispersion or frequency dependence of shear wave propagations.

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

This paper introduces methods to generate crawling wave interference patterns from the displacement fields generated from radiation force pushes on a GE Logiq 9 scanner. The same transducer and system provides both the pushing pulses to generate the shear waves and the tracking pulses to measure the displacements. Acoustic power and system limitations result in largely impulsive displacement fields. Measured displacements from pushes on either side of a region-of-interest (ROI) are used to calculate continuously varying interference patterns. This technique is explained along with a brief discussion of the conventional mechanical source-driven crawling waves for comparison. We demonstrate the method on three example cases: a gelatin-based phantom with a cylindrical inclusion, an oil-gelatin phantom and mouse livers. The oil-gelatin phantom and the mouse livers demonstrate not only shear speed estimation, but the frequency dependence of the shear wave speeds.

Crawling wave detection of prostate cancer: preliminary in vitro results

PURPOSE

The focus of this article is to develop signal and imaging processing methods to derive an accurate estimation of local tissue elasticity using the crawling wave (CrW) sonoelastography method. The task is to reduce noise and to improve the contrast of the elasticity map.

METHODS

The protocol of the CrW approach was first tested on heterogeneous elastic phantoms as a model of prostate cancers. Then, the contrast-to-noise ratio of the estimation was calculated iteratively with various sequences of algorithms to determine the optimal signal processing settings. Finally, the optimized signal processing was applied to ex vivo prostate cancer detection. The comparison of the segmented elasticity map and the histology tumor outline was made by quadrants to evaluate the diagnostic performance of the protocol. Furthermore, the CrW approach was combined with amplitude-sonoelastography to achieve a higher specificity.

RESULTS

This study demonstrated the feasibility of the proposed approach for clinical applications. In the application to ex vivo prostate cancer detection, the established approach was tested on 43 excised prostate glands. The combination of the CrW approach and amplitude-sonoelastography achieved an accuracy of over 80% for finding tumors larger than 4 mm in diameter. The elasticity values and contrast found by the CrW approach were in agreement with the previous results derived from mechanical testing.

CONCLUSIONS

Crawling waves can be applied to detect prostate cancer with accuracy approaching 80% and can quantify the stiffness or shear modulus of both cancerous and noncancerous tissues. The technique therefore shows promise for guiding biopsies to suspect regions that are otherwise difficult to identify.

What challenges must be overcome before ultrasound elasticity imaging is ready for the clinic?

Ultrasound elasticity imaging has been a research interest for the past 20 years with the goal of generating novel images of soft tissues based on their material properties (i.e., stiffness and viscosity). The motivation for such an imaging modality lies in the fact that many soft tissues can share similar ultrasonic echogenicities, but may have very different mechanical properties that can be used to clearly visualize normal anatomy and delineate diseased tissues and masses. Recently, elasticity imaging techniques have moved from the laboratory to the clinical setting, where clinicians are beginning to characterize tissue stiffness as a diagnostic metric and commercial implementations of ultrasonic elasticity imaging are beginning to appear on the market. This article provides a foundation for elasticity imaging, an overview of current research and commercial realizations of elasticity imaging technology and a perspective on the current successes, limitations and potential for improvement of these imaging technologies.

Two-dimensional shear wave speed and crawling wave speed recoveries from in vitro prostate data

The crawling wave experiment was developed to capture a shear wave induced moving interference pattern that is created by two harmonic vibration sources oscillating at different but almost the same frequencies. Using the vibration sonoelastography technique, the spectral variance image reveals a moving interference pattern. It has been shown that the speed of the moving interference pattern, i.e., the crawling wave speed, is proportional to the shear wave speed with a nonlinear factor. This factor can generate high-speed artifacts in the crawling wave speed images that do not actually correspond to increased stiffness. In this paper, an inverse algorithm is developed to reconstruct both the crawling wave speed and the shear wave speed using the phases of the crawling wave and the shear wave. The feature for the data is the application to in vitro prostate data, while the features for the algorithm include the following: (1) A directional filter is implemented to obtain a wave moving in only one direction; and (2) an L(1) minimization technique with physics inspired constraints is employed to calculate the phase of the crawling wave and to eliminate jump discontinuities from the phase of the shear wave. The algorithm is tested on in vitro prostate data measured at the Rochester Center for Biomedical Ultrasound and University of Rochester. Each aspect of the algorithm is shown to yield image improvement. The results demonstrate that the shear wave speed images can have less artifacts than the crawling wave images. Examples are presented where the shear wave speed recoveries have excellent agreement with histology results on the size, shape, and location of cancerous tissues in the glands.

Acoustic radiation force impulse elastography for hepatocellular carcinoma-associated radiofrequency ablation

AIM: To evaluate the potential usefulness of acoustic radiation force impulse (ARFI) images for evaluation of hepatocellular carcinomas (HCC)-associated radiofrequency ablation.

METHODS: From January 2010 to June 2010, a total of 38 patients with HCC including recurred HCCs after RFA underwent ARFI elastography. The brightness of tumor was checked and the shear wave velocity was measured for the quantification of stiffness. According to the brightness, the tumors were classified as brighter, same color and darker compared with adjacent parenchyma. Using the same methods, 8 patients with recurred HCCs after RFA state were evaluated about the brightness compared with adjacent RFA ablation area.

RESULTS: In the 38 patients with HCCs, 20 (52.6%) were brighter than surrounding cirrhotic parenchyma. Another 13 (34.2%) were darker. The others (5 cases, 13.2%) were seen as the same color as the adjacent liver parenchyma. Post-RFA lesions were darker than previous tumor and surrounding parenchyma in all 38 cases. However, recurred HCCs were brighter than the treated site in all 8 cases.

CONCLUSION: Using ARFI technique is helpful for differential diagnosis in order to detect recurred HCCs more easily in patients with confusing status.

Theoretical Analysis of Shear Wave Interference Patterns by Means of Dynamic Acoustic Radiation Forces

Acoustic radiation forces associated with high intensity focused ultrasound stimulate shear wave propagation allowing shear wave speed and shear viscosity estimation of tissue structures. As wave speeds are meters per second, real time displacement tracking over an extend field-of-view using ultrasound is problematic due to very high frame rate requirements. However, two spatially separated dynamic external sources can stimulate shear wave motion leading to shear wave interference patterns. Advantages are shear waves can be imaged at lower frame rates and local interference pattern spatial properties reflect tissue's viscoelastic properties. Here a theoretical analysis of shear wave interference patterns by means of dynamic acoustic radiation forces is detailed. Using a viscoelastic Green's function analysis, tissue motion due to a pair of focused ultrasound beams and associated radiation forces are presented. Overall, this paper theoretically demonstrates shear wave interference patterns can be stimulated using dynamic acoustic radiation forces and tracked using conventional ultrasound imaging.

Imaging the elastic properties of tissue: the 20 year perspective

After 20 years of innovation in techniques that specifically image the biomechanical properties of tissue, the evolution of elastographic imaging can be viewed from its infancy, through a proliferation of approaches to the problem to incorporation on research and then clinical imaging platforms. Ultimately this activity has culminated in clinical trials and improved care for patients. This remarkable progression represents a leading example of translational research that begins with fundamentals of science and engineering and progresses to needed improvements in diagnostic and monitoring capabilities applied to major categories of disease, surgery and interventional procedures. This review summarizes the fundamental principles, the timeline of developments in major categories of elastographic imaging, and concludes with recent results from clinical trials and forward-looking issues.

Tissue quantification with acoustic radiation force impulse imaging: Measurement repeatability and normal values in the healthy liver

OBJECTIVE

The purpose of this study was to describe the most reliable measurement procedure for acoustic radiation force impulse technology and to define the normal wave velocity values in a healthy liver.

SUBJECTS AND METHODS

Twenty healthy volunteers underwent acoustic radiation force impulse imaging tissue quantification and were enrolled in this prospective study. All patients were examined by two independent operators at the same time. Twenty-four measurements per subject were obtained. Intraoperator and interoperator evaluations were performed. Statistical comparison of all mean data was performed with Student's t test. A value of p < 0.05 was considered significant. A comparative analysis was performed, and interclass correlation coefficients were calculated.

RESULTS

The operators obtained 960 measurements. A statistically significant difference was found between the mean shear wave velocity values obtained by one operator deep in the right lobe of the liver and the values obtained on the surface of the right lobe (1.56 vs 1.90 m/s) and between the mean values obtained deep in the right lobe and those obtained deep in the left lobe (1.56 vs 1.84 m/s). The other operator had similar results. The distribution of all mean values obtained by both operators deep in the right hepatic lobe exhibited less dispersion (95% CI, 1.391-1.725) than those obtained on the surface (95% CI, 1.664-2.136). In 77.5% of cases, the shear wave speeds were between 1 and 2 m/s. No statistically significant difference was found in the comparisons performed on the right hepatic lobe by the two operators. The interclass correlation coefficient calculated for measurements deep in the right lobe was 0.87 (p < 0.0001).

CONCLUSION

Acoustic radiation force impulse imaging quantification of hepatic tissue is more reproducible when applied to the deeper portion of the right lobe of the liver.

Crawling waves from radiation force excitation

Crawling waves are generated by an interference of two oscillating waves traveling in opposite directions, with a progressive movement resulting from a frequency difference or a phase difference between the sources. While the idea has been applied to numerous applications, all the previous reports used mechanical sources to vibrate the medium. It is shown, through experiments and simulation, that crawling waves can be generated from focused beams that produce radiation force excitation within the tissue. Some examples are also shown.

Shear wave speed recovery in sonoelastography using crawling wave data

The crawling wave experiment, in which two harmonic sources oscillate at different but nearby frequencies, is a development in sonoelastography that allows real-time imaging of propagating shear wave interference patterns. Previously the crawling wave speed was recovered and used as an indicator of shear stiffness; however, it is shown in this paper that the crawling wave speed image can have artifacts that do not represent a change in stiffness. In this paper, the locations and shapes of some of the artifacts are exhibited. In addition, a differential equation is established that enables imaging of the shear wave speed, which is a quantity strongly correlated with shear stiffness change. The full algorithm is as follows: (1) extract the crawling wave phase from the spectral variance data; (2) calculate the crawling wave phase wave speed; (3) solve a first-order PDE for the phase of the wave emanating from one of the sources; and (4) compute and image the shear wave speed on a grid in the image plane.

Imaging techniques in pancreatic tumors

Conventional ultrasonography represents the first diagnostic imaging modality for the study of pancreatic tumors. Contrast-enhanced ultrasound has significantly improved the accuracy of first-line examination and may influence the choice of second-line investigations: multidetector computed tomography is considered the gold standard for studying pancreatic solid lesions and tumor staging, while MRI with magnetic resonance cholangiopancreatography allows better study of pancreatic cystic lesions and the ductal system. To definitely diagnose a pancreatic lesion, image-guided fine-needle-aspiration or biopsy are very often required. PET with 18-fluorodeoxyglucose, endoscopic ultrasound and intraoperative ultrasonography remain techniques often employed in the third line. This article reviews the imaging techniques generally used for diagnosing the main pancreatic tumors, and a work-up algorithm is finally proposed.

Acoustic Radiation Force Impulse (ARFI) technique in ultrasound with Virtual Touch tissue quantification of the upper abdomen

PURPOSE

Virtual Touch tissue quantification is an implementation of ultrasound (US) Acoustic Radiation Force Impulse (ARFI) imaging that provides numerical measurements (wave-velocity values) of tissue stiffness. The aim of this study was to define the normal values of shear-wave speed for the healthy liver, gallbladder, pancreas, spleen and kidneys.

MATERIALS AND METHODS

Thirty-five young healthy volunteers underwent Virtual Touch tissue quantification after having signed an informed consent form. All upper abdominal organs were examined by two independent operators. A phantom fluid model was also evaluated. All mean wave-velocity values were analysed and compared. Results. One hundred and forty measurements of liver, pancreas, spleen and kidneys, and 70 measurements of the gallbladder lumen were performed. Twenty measurements on the phantom were also performed. Comparing all measurements separately made by each operator in different parts of the organs, no statistically significant differences were observed. A "XXXX/0" value was always obtained from all measurements performed on the gallbladder lumen and on the phantom fluid model. Liver, pancreas, spleen and kidney mean values were 1.59 m/s, 1.40 m/s, 2.44 m/s and 2.24 m/s, respectively.

CONCLUSIONS

Virtual Touch tissue quantification is a new, promising implementation of the US ARFI technique, which provides numerical measurements of tissue stiffness. The mean shear-wave speed is lower in the pancreatic parenchyma than in the liver and kidney, whereas the spleen is characterised by the highest mean value. In simple fluids such as water, the value identified by the system with "XXXX" or 0, is always measured.

Calculating tissue shear modulus and pressure by 2D Log-Elastographic methods

Shear modulus imaging, often called elastography, enables detection and characterization of tissue abnormalities. In this paper the data is two displacement components obtained from successive MR or ultrasound data sets acquired while the tissue is excited mechanically. A 2D plane strain elastic model is assumed to govern the 2D displacement, u. The shear modulus, μ, is unknown and whether or not the first Lamé parameter, λ, is known the pressure p = λ∇ · u which is present in the plane strain model cannot be measured and is unreliably computed from measured data and can be shown to be an order one quantity in the units kPa. So here we present a 2D Log-Elastographic inverse algorithm that: (1) simultaneously reconstructs the shear modulus, μ, and p, which together satisfy a first order partial differential equation system, with the goal of imaging μ; (2) controls potential exponential growth in the numerical error; and (3) reliably reconstructs the quantity p in the inverse algorithm as compared to the same quantity computed with a forward algorithm. This work generalizes the Log-Elastographic algorithm in [20] which uses one displacement component, is derived assuming the component satisfies the wave equation, and is tested on synthetic data computed with the wave equation model. The 2D Log-Elastographic algorithm is tested on 2D synthetic data and 2Din-vivo data from Mayo Clinic. We also exhibit examples to show that the 2D Log-Elastographic algorithm improves the quality of the recovered images as compared to the Log-Elastographic and Direct Inversion algorithms.

Two-dimensional sonoelastographic shear velocity imaging

We introduce a novel 2-D sonoelastographic technique for estimating local shear velocities from propagating shear wave interference patterns (termed crawling waves) in this paper. A relationship between the local crawling wave spatial phase derivatives and local shear wave velocity is derived, with phase derivatives estimated using a 2-D autocorrelation technique. Comparisons were made between the 2-D sonoelastographic shear velocity estimation technique and its computationally simpler 1-D precursor. In general, the 2-D sonoelastographic shear velocity estimator outperformed the 1-D-based technique in terms of accuracy and estimator noise minimization. For both approaches, increasing the estimator kernel size reduces noise levels but lowers spatial resolution. Homogeneous elastic phantom results demonstrate the ability of sonoelastographic shear velocity imaging to quantify the true underlying shear velocity distributions as verified using time-of-flight measurements. Results also indicate that increasing the estimator kernel size increases the transition zone length about boundaries in heterogeneous elastic mediums and may complicate accurate quantification of smaller elastically contrasting lesions. Furthermore, analysis of contrast-to-noise ratio (CNR) values for sonoelastograms obtained in heterogeneous elastic phantoms reveal that the 2-D sonoelastographic shear velocity estimation technique outperforms the 1-D version for a given kernel size in terms of image noise minimization and contrast enhancement. Experimental results from an embedded porcine liver specimen with a radiofrequency ablation (RFA) lesion demonstrates that the 2-D sonoelastographic shear velocity estimation technique minimizes image noise artifacts and yields a consistent lesion boundary when compared with gross pathology. Volume measurements of the RFA lesion obtained from shear velocity sonoelastograms was comparable to that obtained by fluid displacement of the dissected lesion as illustrated by 3-D volume reconstructions. Overall, 2-D sonoelastographic shear velocity imaging was shown to be a promising new approach to characterizing the shear velocity distribution of elastic materials.