Comparison of fundamental, second harmonic, and superharmonic imaging: a simulation study

Experimental and simulation study of harmonic components generated by plane and focused waves

Although there is increasing interest in the use of plane waves (PW) in high-frame-rate imaging, not much experimental data is available about their behavior in terms of nonlinear propagation. This paper presents a detailed study of fundamental and harmonic components of the ultrasound beam associated to PW transmission from a linear array. Simulations and hydrophone measurements of PW propagation in water were performed and compared to the results obtained for focused waves (FWs) at various levels of peak negative pressure (PNP). Experimental results confirm that, at comparable PNP, the amplitudes of the harmonics reached by PWs are always higher, over extended regions, than those achieved with FW. For example, at MI = 0.2 the PW second harmonic turns out to be 9 dB higher at 25 mm depth (i.e. in the focal region), and 20 dB higher at 40 mm depth. Simulations additionally show that when ultrasound waves propagate through blood or muscle, the situation is in general reversed but, at low MI, the second harmonic amplitude can still be higher in PW than in FW. Furthermore, it is shown that increasing the array aperture size yields higher harmonic growth in PW compared to FW.

Experimental evaluation of ultrasound higher-order harmonic imaging with Filtered-Delay Multiply And Sum (F-DMAS) non-linear beamforming

Tissue Harmonic Imaging (THI) mode is currently one of the preferred choices by the clinicians for its ability to provide enhanced ultrasound images, thanks to the use of the second harmonic component of backscattered echoes. This paper aims at investigating whether the combination of THI with Filtered-Delay Multiply And Sum (F-DMAS) beamforming can provide further improvements in image quality. F-DMAS is a new non-linear beamformer, which, similarly to THI, is based on the use of the second harmonics of beamformed signals and is known to increase image contrast resolution and noise rejection. Thus, we have first compared the images obtained by using F-DMAS and the standard Delay And Sum (DAS) beamformers when only the second harmonics of the received signals was selected. Moreover, possible improvements brought about by other harmonic components generated by the combined use of the fundamental plus second harmonics and F-DMAS beamforming have been explored. Experimental results demonstrate that, as compared to standard harmonic imaging with DAS, THI and F-DMAS can be joined to improve the -20 dB lateral resolution up to 1 mm, the contrast ratio up to 12 dB on a cyst-phantom and up to 9 dB on in vivo images.

Imaging with ultrasound contrast agents: current status and future

Microbubble ultrasound contrast agents (UCAs) were recently approved by the Food and Drug administration for non-cardiac imaging. The physical principles of UCAs, methods of administration, dosage, adverse effects, and imaging techniques both current and future are described. UCAs consist of microbubbles in suspension which strongly interact with the ultrasound beam and are readily detectable by ultrasound imaging systems. They are confined to the blood pool when administered intravenously, unlike iodinated and gadolinium contrast agents. UCAs have a proven safety record based on over two decades of use, during which they have been used in echocardiography in the U.S. and for non-cardiac imaging in the rest of the world. Adverse effects are less common with UCAs than CT/MR contrast agents. Compared to CT and MR, contrast-enhanced ultrasound has the advantages of real-time imaging, portability, and reduced susceptibility to metal and motion artifact. UCAs are not nephrotoxic and can be used in renal failure. High acoustic amplitudes can cause microbubbles to fragment in a manner that can result in short-term increases in capillary permeability or capillary rupture. These bioeffects can be beneficial and have been used to enhance drug delivery under appropriate conditions. Imaging with a mechanical index of < 0.4 preserves the microbubbles and is not typically associated with substantial bioeffects. Molecularly targeted ultrasound contrast agents are created by conjugating the microbubble shell with a peptide, antibody, or other ligand designed to target an endothelial biomarker associated with tumor angiogenesis or inflammation. These microbubbles then accumulate in the microvasculature at target sites where they can be imaged. Ultrasound contrast agents are a valuable addition to the diagnostic imaging toolkit. They will facilitate cross-sectional abdominal imaging in situations where contrast-enhanced CT and MR are contraindicated or impractical.

Calibration of focused ultrasonic transducers and absolute measurements of fluid nonlinearity with diffraction and attenuation corrections

This paper presents analytical and experimental techniques for absolute determination of the acoustic nonlinearity parameter (β) in fluids using focused transducers. When focused transducers are used for β measurements, the geometrical and mechanical calibrations are generally required for accurate determination of the receiver transfer function from which the absolute pressure can be calculated. The fundamental and second harmonic wave amplitudes in harmonic generation measurements should be modified to account for beam diffraction and material absorption. All these issues are resolved in this study and the proposed technique is validated through the β measurement in water. An experimental method is developed to determine the effective radius and focal length of focused transducers. A simplified self-reciprocity calibration procedure for a broadband focused receiver is described. The diffraction and attenuation corrections for the fundamental and second harmonic waves are explicitly derived using the multi-Gaussian beam model, and the effects on the β determination are discussed. When the diffraction and attenuation corrections are all properly made, the measurement of β over a large range of propagation distances is possible with errors less than 8%.

Superharmonic Imaging for Medical Ultrasound: a Review

Ultrasound with harmonics has emerged as an exceptional alternative to competitively low resolution fundamental ultrasound imaging. The use of second harmonic is already a trend now but higher harmonics are also being seen as even better option due to its improved resolution. The resolution improved with frequency but achieves penetration of reduced energy. The cumulative addition of higher harmonics during propagation yields higher harmonics giving better resolution with adequate penetration. This paper summarizes the progress of such similar decade old harmonic ultrasound imaging technique i.e., superharmonic imaging (SHI) geared towards medical field. It comprises of harmonics higher than second harmonic preferably up to 5th harmonic. We conclude that SHI can be an advanced ultrasound imaging with comprehensive high resolution and adequate penetration depth on sole and coded modes.

Contrast agents in diagnostic imaging: Present and future

Specific contrast agents have been developed for x ray examinations (mainly CT), sonography and Magnetic Resonance Imaging. Most of them are extracellular agents which create different enhancement on basis of different vascularization or on basis of different interstitial network in tissues, but some can be targeted to a particular cell line (e.g. hepatocyte). Microbubbles can be used as carrier for therapeutic drugs which can be released in specific targets under sonographic guidance, decreasing systemic toxicity and increasing therapeutic effect. Radiologists have to choose a particular contrast agent knowing its physical and chemical properties and the possibility of adverse reactions and balancing them with the clinical benefits of a more accurate diagnosis. As for any drug, contrast agents can cause adverse events, which are more frequent with Iodine based CA, but also with Gd based CA and even with sonographic contrast agents hypersensitivity reaction can occur.

Visualizing the Tumor Microvasculature With a Nonlinear Plane-Wave Doppler Imaging Scheme Based on Amplitude Modulation

Imaging with ultrasonic plane waves enables the combination of Doppler and microbubble contrast-enhanced imaging without compromising the Doppler ensemble length, as is the case for conventional line-by-line imaging, thus maintaining flow sensitivity. This permits the separation of conduit flow in large vessels from the perfusion background and the presentation of velocity estimates in real-time. However, the ability to differentiate perfusion from the tissue signal is limited by the contrast-to-tissue (CTR) ratio achieved with the contrast-enhanced pulsing sequence, independently of the acquisition length. One way to improve the CTR is to use a Doppler sequence based on amplitude modulation instead of one based on pulse inversion. In this work, we discuss how amplitude modulation can be adapted to Doppler processing. We show that amplitude modulation Doppler, like pulse inversion Doppler, can separate the signal of moving tissue from that of moving microbubbles, while achieving a better contrast-to-tissue ratio than pulse inversion Doppler, both in vitro and in vivo. Both amplitude modulation Doppler and pulse inversion Doppler yield similar velocity estimates when the bandwidth of the RF echo is properly compensated. Finally, we demonstrate how amplitude modulation Doppler can be used to reveal both the conduit flow and the capillary perfusion at high frame rates in an in vivo tumor.

Modeling of wave propagation for medical ultrasound: a review

Numerical modeling of medical ultrasound has advanced tremendously in the past two decades. This opens up a great number of opportunities for medical ultrasound and associated technologies. Numerous new governing equations and algorithms have emerged and been applied to studying various medical ultrasound applications, including ultrasound imaging, photo-acoustic imaging, and therapeutic ultrasound. In addition, thanks to the rapid development of computers, modeling acoustic wave propagation in three-dimensional, large-scale domains has become a reality. This article will provide an indepth literature and technical review of recent progress on numerical modeling of medical ultrasound. Future challenges will also be discussed.

Experimental validation of a convolution- based ultrasound image formation model using a planar arrangement of micrometer-scale scatterers

The shift-invariant convolution model of ultrasound is widely used in the literature, for instance to generate fast simulations of ultrasound images. However, comparison of the resulting simulations with experiments is either qualitative or based on aggregate descriptors such as envelope statistics or spectral components. In the current work, a planar arrangement of 49-μm polystyrene microspheres was imaged using macrophotography and a 4.7-MHz ultrasound linear array. The macrophotograph allowed estimation of the scattering function (SF) necessary for simulations. Using the coefficient of determination R(2) between real and simulated ultrasound images, different estimates of the SF and point spread function (PSF) were tested. All estimates of the SF performed similarly, whereas the best estimate of the PSF was obtained by Hanningwindowing the deconvolution of the real ultrasound image with the SF: this yielded R(2) = 0.43 for the raw simulated image and R(2) = 0.65 for the envelope-detected ultrasound image. R(2) was highly dependent on microsphere concentration, with values of up to 0.99 for regions with scatterers. The results validate the use of the shift-invariant convolution model for the realistic simulation of ultrasound images. However, care needs to be taken in experiments to reduce the relative effects of other sources of scattering such as from multiple reflections, either by increasing the concentration of imaged scatterers or by more careful experimental design.

In vitro and in vivo tissue harmonic images obtained with parallel transmit beamforming by means of orthogonal frequency division multiplexing

In classic pulse-echo ultrasound imaging, the data acquisition rate is limited by the speed of sound. To overcome this, parallel beamforming techniques in transmit (PBT) and in receive (PBR) mode have been proposed. In particular, PBT techniques, based on the transmission of focused beams, are more suitable for harmonic imaging because they are capable of generating stronger harmonics. Recently, orthogonal frequency division multiplexing (OFDM) has been investigated as a means to obtain parallel beamformed tissue harmonic images. To date, only numerical studies and experiments in water have been performed, hence neglecting the effect of frequencydependent absorption. Here we present the first in vitro and in vivo tissue harmonic images obtained with PBT by means of OFDM, and we compare the results with classic B-mode tissue harmonic imaging. The resulting contrast-to-noise ratio, here used as a performance metric, is comparable. A reduction by 2 dB is observed for the case in which three parallel lines are reconstructed. In conclusion, the applicability of this technique to ultrasonography as a means to improve the data acquisition rate is confirmed.

Superharmonic imaging with chirp coded excitation: filtering spectrally overlapped harmonics

Superharmonic imaging improves the spatial resolution by using the higher order harmonics generated in tissue. The superharmonic component is formed by combining the third, fourth, and fifth harmonics, which have low energy content and therefore poor SNR. This study uses coded excitation to increase the excitation energy. The SNR improvement is achieved on the receiver side by performing pulse compression with harmonic matched filters. The use of coded signals also introduces new filtering capabilities that are not possible with pulsed excitation. This is especially important when using wideband signals. For narrowband signals, the spectral boundaries of the harmonics are clearly separated and thus easy to filter; however, the available imaging bandwidth is underused. Wideband excitation is preferable for harmonic imaging applications to preserve axial resolution, but it generates spectrally overlapping harmonics that are not possible to filter in time and frequency domains. After pulse compression, this overlap increases the range side lobes, which appear as imaging artifacts and reduce the Bmode image quality. In this study, the isolation of higher order harmonics was achieved in another domain by using the fan chirp transform (FChT). To show the effect of excitation bandwidth in superharmonic imaging, measurements were performed by using linear frequency modulated chirp excitation with varying bandwidths of 10% to 50%. Superharmonic imaging was performed on a wire phantom using a wideband chirp excitation. Results were presented with and without applying the FChT filtering technique by comparing the spatial resolution and side lobe levels. Wideband excitation signals achieved a better resolution as expected, however range side lobes as high as -23 dB were observed for the superharmonic component of chirp excitation with 50% fractional bandwidth. The proposed filtering technique achieved >50 dB range side lobe suppression and improved the image quality without affecting the axial resolution.

Implementation of parallel transmit beamforming using orthogonal frequency division multiplexing--achievable resolution and interbeam interference

The speed of sound in the human body limits the achievable data acquisition rate of pulsed ultrasound scanners. To overcome this limitation, parallel beamforming techniques are used in ultrasound 2-D and 3-D imaging systems. Different parallel beamforming approaches have been proposed. They may be grouped into two major categories: parallel beamforming in reception and parallel beamforming in transmission. The first category is not optimal for harmonic imaging; the second category may be more easily applied to harmonic imaging. However, inter-beam interference represents an issue. To overcome these shortcomings and exploit the benefit of combining harmonic imaging and high data acquisition rate, a new approach has been recently presented which relies on orthogonal frequency division multiplexing (OFDM) to perform parallel beamforming in transmission. In this paper, parallel transmit beamforming using OFDM is implemented for the first time on an ultrasound scanner. An advanced open platform for ultrasound research is used to investigate the axial resolution and interbeam interference achievable with parallel transmit beamforming using OFDM. Both fundamental and second-harmonic imaging modalities have been considered. Results show that, for fundamental imaging, axial resolution in the order of 2 mm can be achieved in combination with interbeam interference in the order of -30 dB. For second-harmonic imaging, axial resolution in the order of 1 mm can be achieved in combination with interbeam interference in the order of -35 dB.

Computation of nonlinear ultrasound fields using a linearized contrast source method

Nonlinear ultrasound is important in medical diagnostics because imaging of the higher harmonics improves resolution and reduces scattering artifacts. Second harmonic imaging is currently standard, and higher harmonic imaging is under investigation. The efficient development of novel imaging modalities and equipment requires accurate simulations of nonlinear wave fields in large volumes of realistic (lossy, inhomogeneous) media. The Iterative Nonlinear Contrast Source (INCS) method has been developed to deal with spatiotemporal domains measuring hundreds of wavelengths and periods. This full wave method considers the nonlinear term of the Westervelt equation as a nonlinear contrast source, and solves the equivalent integral equation via the Neumann iterative solution. Recently, the method has been extended with a contrast source that accounts for spatially varying attenuation. The current paper addresses the problem that the Neumann iterative solution converges badly for strong contrast sources. The remedy is linearization of the nonlinear contrast source, combined with application of more advanced methods for solving the resulting integral equation. Numerical results show that linearization in combination with a Bi-Conjugate Gradient Stabilized method allows the INCS method to deal with fairly strong, inhomogeneous attenuation, while the error due to the linearization can be eliminated by restarting the iterative scheme.

Single pulse frequency compounding protocol for superharmonic imaging

Second harmonic imaging is currently accepted as the standard in commercial echographic systems. A new imaging technique, coined as superharmonic imaging (SHI), combines the third till the fifth harmonics, arising during nonlinear sound propagation. It could further enhance the resolution and quality of echographic images. To meet the bandwidth requirement for SHI a dedicated phased array has been developed: a low frequency subarray, intended for transmission, interleaved with a high frequency subarray, used in reception. As the bandwidth of the elements is limited, the spectral gaps in between the harmonics cause multiple (ghost) reflection artifacts. A dual-pulse frequency compounding method aims at suppressing those artifacts at a price of a reduced frame rate. In this study we explore a possibility of performing frequency compounding within a single transmission. The traditional frequency compounding method suppresses the ripples by consecutively emitting two short Gaussian bursts with a slightly different center frequency. In the newly proposed method, the transmit aperture is divided into two parts: the first half is used to send a pulse at the lower center frequency, while the other half simultaneously transmits at a slightly higher center frequency. The suitability of the protocol for medical imaging applications in terms of the steering capabilities was performed in a simulation study with INCS and the hydrophone measurements. Moreover, an experimental study was carried out to find the optimal parameters for the clinical imaging protocol. The latter was subsequently used to obtain the images of a tissue mimicking phantom containing strongly reflecting wires. Additionally, the images of a human heart in the parasternal projection were acquired. The scanning aperture with the developed protocol amounts to approximately 90°, which is sufficient to capture the cardiac structures in the standard anatomical projections. The theoretically estimated and experimentally measured grating lobe levels are equal to -28.3 dB and -35.9 dB, respectively. A considerable improvement in the axial resolution of the SHI component (0.73 mm) at -6 dB in comparison with the third harmonic (2.23 mm) was observed. A similar comparison in terms of the lateral resolution slightly favored the superharmonic component by 0.2 mm. Additionally, the images of the tissue mimicking phantom exhibited the absence of the multiple reflection artifacts. The in-vivo acquisition allows one to clearly observe the dynamic of the mitral valve leaflets. The new method is equally effective in eliminating the ripple artifacts associated with SHI as the dual-pulse technique, while the full frame rate is maintained.

Current status and prospects for microbubbles in ultrasound theranostics

Encapsulated microbubbles have been developed over the past two decades to provide improvements both in imaging as well as new therapeutic applications. Microbubble contrast agents are used currently for clinical imaging where increased sensitivity to blood flow is required, such as echocardiography. These compressible spheres oscillate in an acoustic field, producing nonlinear responses which can be uniquely distinguished from surrounding tissue, resulting in substantial enhancements in imaging signal-to-noise ratio. Furthermore, with sufficient acoustic energy the oscillation of microbubbles can mediate localized biological effects in tissue including the enhancement of membrane permeability or increased thermal energy deposition. Structurally, microbubbles are comprised of two principal components--an encapsulating shell and an inner gas core. This configuration enables microbubbles to be loaded with drugs or genes for additional therapeutic effect. Application of sufficient ultrasound energy can release this payload, resulting in site-specific delivery. Extensive preclinical studies illustrate that combining microbubbles and ultrasound can result in enhanced drug delivery or gene expression at spatially selective sites. Thus, microbbubles can be used for imaging, for therapy, or for both simultaneously. In this sense, microbubbles combined with acoustics may be one of the most universal theranostic tools.