Quantitative ultrasound imaging for monitoring in situ high-intensity focused ultrasound exposure

Simulation of ultrasonic scattering from scatterer size distributions using Field II

Quantitative analysis of radio frequency (RF) signals obtained from ultrasound scanners can yield objective parameters that are gaining clinical relevance as imaging biomarkers. These include the backscatter coefficient (BSC) and the effective scatterer diameter (ESD). Biomarker validation is typically performed in phantoms which do not provide the flexibility of systematic variation of scattering properties. Computer simulations, such as those from the ultrasound simulator Field II, can allow more flexibility. However, Field II does not allow simulation of RF data from a distribution of scatterers with finite size. In this work, a simulation method is presented which builds upon previous work by including Faran theory models representative of distributions of scatterer size. These are systematically applied to RF data simulated in Field II. The method is validated by measuring the root mean square error of the estimated BSC and percent bias of the ESD and comparing to experimental results. The results indicate the method accurately simulates distributions of scatterer sizes and provides scattering similar to that seen in data from clinical scanners. Because Field II is widely used by the ultrasound community, this method can be adopted to aid in validation of quantitative ultrasound imaging biomarkers.

Implementation of Non-Invasive Quantitative Ultrasound in Clinical Cancer Imaging

Quantitative ultrasound (QUS) is a non-invasive novel technique that allows treatment response monitoring. Studies have shown that QUS backscatter variables strongly correlate with changes observed microscopically. Increases in cell death result in significant alterations in ultrasound backscatter parameters. In particular, the parameters related to scatterer size and scatterer concentration tend to increase in relation to cell death. The use of QUS in monitoring tumor response has been discussed in several preclinical and clinical studies. Most of the preclinical studies have utilized QUS for evaluating cell death response by differentiating between viable cells and dead cells. In addition, clinical studies have incorporated QUS mostly for tissue characterization, including classifying benign versus malignant breast lesions, as well as responder versus non-responder patients. In this review, we highlight some of the important findings of previous preclinical and clinical studies and expand the applicability and therapeutic benefits of QUS in clinical settings. We summarized some recent clinical research advances in ultrasound-based radiomics analysis for monitoring and predicting treatment response and characterizing benign and malignant breast lesions. We also discuss current challenges, limitations, and future prospects of QUS-radiomics.

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.

Real-Time Volumetric Thermoacoustic Imaging and Thermometry Using a 1.5-D Ultrasound Array

Noninvasive thermal therapies for the treatment of breast cancer depend on accurate monitoring of tissue temperature to optimize treatment and ensure safety. This work describes a real-time system for 3-D thermoacoustic imaging and thermometry (TAI-TAT) for tracking temperature in tissue samples during heating. The study combines a 2.7-GHz microwave pulse generator with a custom 1.5-D 0.6 MHz ultrasound array for generating and detecting TA signals. The system is tested and validated on slabs of biological tissue and saline gel during heating. Calibration curves for relating the TA signal to temperature were calculated in saline gel (3.40%/°C), muscle (1.73%/°C), and fat (1.15%/°C), respectively. The calibrations were used to produce real-time, volumetric temperature maps at ~3-s intervals with a spatial resolution of approximately 3 mm. TAT temperature changes within a region of interest were compared to adjacent thermocouples with a mean error of 17.3%, 13.2%, and 20.4% for muscle, gel, and fat, respectively. The TAT algorithm was also able to simultaneously track temperatures in different tissues. With further development, noninvasive TAI-TAT may prove to be a valuable method for accurate and real-time feedback during breast cancer ablation therapy.

Imaging-based internal body temperature measurements: The journal Temperature toolbox

Noninvasive imaging methods of internal body temperature are in high demand in both clinical medicine and physiological research. Thermography and thermometry can be used to assess tissue temperature during thermal therapies: ablative and hyperthermia treatments to ensure adequate temperature rise in target tissues but also to avoid collateral damage by heating healthy tissues. In research use, measurement of internal body temperature enables us the production of thermal maps on muscles, internal organs, and other tissues of interest. The most used methods for noninvasive imaging of internal body temperature are based on different parameters acquired with magnetic resonance imaging, ultrasound, computed tomography, microwave radiometry, photoacoustic imaging, and near-infrared spectroscopy. In the current review, we examine the aforementioned imaging methods, their use in estimating internal body temperature in vivo with their advantages and disadvantages, and the physical phenomena the thermography or thermometry modalities are based on.

Noninvasive ultrasound imaging for assessment of intact microstructure of extracellular matrix in tissue engineering

Development of artificial tissues or organs is one of the actual tasks in regenerative medicine that requires observation and evaluation of intact volume microstructure of tissue engineering products at all stages of their formation, from native donor tissues and decellularized scaffolds to recipient cell migration in the matrix. Unfortunately in practice, methods of vital noninvasive imaging of volume microstructure in matrixes are absent. In this work, we propose a new approach based on high-frequency acoustic microscopy for noninvasive evaluation and visualization of volume microstructure in tissue engineering products. The results present the ultrasound characterization of native rat diaphragms and lungs and their decellularized scaffolds. Verification of the method for visualization of tissue formation in the matrix volume was described in the model samples of diaphragm scaffolds with stepwise collagenization. Results demonstrate acoustic microscopic sensitivity to cell content concentration, variation in local density, and orientation of protein fibers in the volume, micron air inclusions, and other inhomogeneities of matrixes.

Power Spectrum Consistency among Systems and Transducers

Use of the reference phantom method for computing acoustic attenuation and backscatter is widespread. However, clinical application of these methods has been limited by the need to acquire reference phantom data. We determined that the data acquired from 11 transducers of the same model and five clinical ultrasound systems of the same model produce equivalent estimates of reference phantom power spectra. We describe that the contribution to power spectral density variance among systems and transducers equals that from speckle variance with 59 uncorrelated echo signals. Thus, when the number of uncorrelated lines of data is small, speckle variance will dominate the power spectral density estimate variance introduced by different systems and transducers. These results suggest that, at least for this particular transducer and imaging system combination, one set of reference phantom calibration data is highly representative of the average among equivalent transducers and systems that are in good working order.

Thermoacoustic Lensing in Ultrasound Imaging of Nonechogenic Tissue During High-intensity Focused Ultrasound Exposure

We develop a ray-tracing theory to describe the effects of thermoacoustic lensing during high-intensity focused ultrasound (HIFU) on ultrasound images of reflectors lying distal to the HIFU focal region and discuss the application of thermal lensing effects to dose monitoring in HIFU therapy. By analyzing the effects of thermal and geometric delays of acoustic rays passing through a region of tissue undergoing localized heating, we show how the shape of a reflector distal to the heated region can be predicted and present experimental measurements in good agreement with the model. We also apply the model in reverse to estimate the thermal profile of a heated region based on a measured change in the shape of a distal reflector during HIFU delivery. As an example, we apply this technique to the measurements of thermal diffusion in porcine fat. An interesting aspect of the technique is that it can be applied to measure temperature in nonechogenic tissues as long as there is an observable reflector in the ultrasound images that is located distal to the region of localized heating.

Focused Ultrasound Treatment of Cervical Lymph Nodes in Rats with EAE: A Pilot Study

In this pilot study, focused ultrasound (FUS) was used to produce hyperthermia in cervical lymph nodes of rats having experimental autoimmune encephalomyelitis (EAE) to alleviate symptoms associated with EAE. EAE was induced in dark agouti rats, and EAE scores were recorded over 21 d. At the onset of EAE symptoms, rats were treated with FUS to induce temperatures of 43-44°C for 20 min in the superficial cervical lymph nodes. An EAE remittance score was tallied for all rats, defined as the maximum EAE score observed minus the minimum EAE score observed after the maximum EAE was reached. On average, the peak remittance score for FUS-treated rats was 1.14 ± 0.48 versus 0.33 ± 0.27 for sham-treated rats. These differences were statistically significant (p = 0.037). Therefore, FUS treatment of cervical lymph nodes in rats with EAE resulted in a significant reduction in EAE score.

Quantitative Ultrasound for Monitoring High-Intensity Focused Ultrasound Treatment In Vivo

The success of any minimally invasive treatment procedure can be enhanced significantly if combined with a robust noninvasive imaging modality that can monitor therapy in real time. Quantitative ultrasound (QUS) imaging has been widely investigated for monitoring various treatment responses such as chemotherapy, radiation, and thermal therapy. Previously, we demonstrated the feasibility of using spectral-based QUS parameters to monitor high-intensity focused ultrasound (HIFU) treatment of in situ tumors in euthanized rats [Ultrasonic Imaging 36(4), 239-255, 2014]. In the present study, we examined the use of spectral-based QUS parameters to monitor HIFU treatment of in vivo rat mammary adenocarcinoma tumors (MAT) where significant tissue motion was present. HIFU was applied to tumors in rats using a single-element transducer. During the off part of the HIFU duty cycle, ultrasound backscatter was recorded from the tumors using a linear array co-aligned with the HIFU focus. A total of 10 rats were treated with HIFU in this study with an additional sham-treated rat. Spectral parameters from the backscatter coefficient, i.e., effective scatterer diameter (ESD) and effective acoustic concentration (EAC), were estimated. The changes of each parameter during treatment were compared with a temperature profile recorded by a fine-needle thermocouple inserted into the tumor a few millimeters behind the focus of the HIFU transducer. The mean ESD changed from 121 ±6 to [Formula: see text], and the EAC changed from 33 ±2 to [Formula: see text] during HIFU exposure as the temperature increased on average from 38.7 ±1.0 (°)C to 64.2 ±2.7 (°)C. The changes in ESD and EAC were linearly correlated with the changes in tissue temperature during the treatment. When HIFU was turned off, the ESD increased from 81 ±8 to [Formula: see text] and the EAC dropped from 46 ±3 to 36±2 dB/cm(3) as the temperature decreased from 64.2 ±2.7 (°)C to 45 ±2.7 (°)C. QUS was demonstrated in vivo to track temperature elevations caused by HIFU exposure.

Ultrasound Imaging Techniques for Spatiotemporal Characterization of Composition, Microstructure, and Mechanical Properties in Tissue Engineering

Ultrasound techniques are increasingly being used to quantitatively characterize both native and engineered tissues. This review provides an overview and selected examples of the main techniques used in these applications. Grayscale imaging has been used to characterize extracellular matrix deposition, and quantitative ultrasound imaging based on the integrated backscatter coefficient has been applied to estimating cell concentrations and matrix morphology in tissue engineering. Spectral analysis has been employed to characterize the concentration and spatial distribution of mineral particles in a construct, as well as to monitor mineral deposition by cells over time. Ultrasound techniques have also been used to measure the mechanical properties of native and engineered tissues. Conventional ultrasound elasticity imaging and acoustic radiation force imaging have been applied to detect regions of altered stiffness within tissues. Sonorheometry and monitoring of steady-state excitation and recovery have been used to characterize viscoelastic properties of tissue using a single transducer to both deform and image the sample. Dual-mode ultrasound elastography uses separate ultrasound transducers to produce a more potent deformation force to microscale characterization of viscoelasticity of hydrogel constructs. These ultrasound-based techniques have high potential to impact the field of tissue engineering as they are further developed and their range of applications expands.

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.

Quantitative Ultrasound for Nondestructive Characterization of Engineered Tissues and Biomaterials

Non-invasive, non-destructive technologies for imaging and quantitatively monitoring the development of artificial tissues are critical for the advancement of tissue engineering. Current standard techniques for evaluating engineered tissues, including histology, biochemical assays and mechanical testing, are destructive approaches. Ultrasound is emerging as a valuable tool for imaging and quantitatively monitoring the properties of engineered tissues and biomaterials longitudinally during fabrication and post-implantation. Ultrasound techniques are rapid, non-invasive, non-destructive and can be easily integrated into sterile environments necessary for tissue engineering. Furthermore, high-frequency quantitative ultrasound techniques can enable volumetric characterization of the structural, biological, and mechanical properties of engineered tissues during fabrication and post-implantation. This review provides an overview of ultrasound imaging, quantitative ultrasound techniques, and elastography, with representative examples of applications of these ultrasound-based techniques to the field of tissue engineering.

Noninvasive Quantitative Imaging of Collagen Microstructure in Three-Dimensional Hydrogels Using High-Frequency Ultrasound

Collagen I is widely used as a natural component of biomaterials for both tissue engineering and regenerative medicine applications. The physical and biological properties of fibrillar collagens are strongly tied to variations in collagen fiber microstructure. The goal of this study was to develop the use of high-frequency quantitative ultrasound to assess collagen microstructure within three-dimensional (3D) hydrogels noninvasively and nondestructively. The integrated backscatter coefficient (IBC) was employed as a quantitative ultrasound parameter to detect, image, and quantify spatial variations in collagen fiber density and diameter. Collagen fiber microstructure was varied by fabricating hydrogels with different collagen concentrations or polymerization temperatures. IBC values were computed from measurements of the backscattered radio-frequency ultrasound signals collected using a single-element transducer (38-MHz center frequency, 13-47 MHz bandwidth). The IBC increased linearly with increasing collagen concentration and decreasing polymerization temperature. Parametric 3D images of the IBC were generated to visualize and quantify regional variations in collagen microstructure throughout the volume of hydrogels fabricated in standard tissue culture plates. IBC parametric images of corresponding cell-embedded collagen gels showed cell accumulation within regions having elevated collagen IBC values. The capability of this ultrasound technique to noninvasively detect and quantify spatial differences in collagen microstructure offers a valuable tool to monitor the structural properties of collagen scaffolds during fabrication, to detect functional differences in collagen microstructure, and to guide fundamental research on the interactions of cells and collagen matrices.

Thermometry and ablation monitoring with ultrasound

In this review we present the current status of ultrasound thermometry and ablation monitoring, with emphasis on the diverse approaches published in the literature and with an eye on which methods are closest to clinical reality. It is hoped that this review will serve as a guide to the expansion of sonographic methods for treatment monitoring and thermometry since the last brief review in 2007.