New semi-analytical method for fast transcranial ultrasonic field simulation

Objective.To optimize and ensure the safety of ultrasound brain therapy, personalized transcranial ultrasound simulations are very useful. They allow to predict the pressure field, depending on the patient skull and probe position. Most transcranial ultrasound simulations are based on numerical methods which have a long computation time and a high memory usage. The goal of this study is to develop a new semi-analytical field computation method that combines realism and computation speed.Approach.Instead of the classic ray tracing, the ultrasonic paths are computed by time of flight minimization. Then the pressure field is computed using the pencil method. This method requires a smooth and homogeneous skull model. The simulation algorithm, so-called SplineBeam, was numerically validated, by comparison with existing solvers, and experimentally validated by comparison with hydrophone measured pressure fields through anex vivohuman skull.Main results.SplineBeam simulated pressure fields were close to the experimentally measured ones, with a focus position difference of the order of the positioning error and a maximum pressure difference lower than 6.02%. In addition, for those configurations, SplineBeam computation time was lower than another simulation software, k-Wave's, by two orders of magnitude, thanks to its capacity to compute the field only at the focal spot.Significance.These results show the potential of this new method to compute fast and realistic transcranial pressure fields. The combination of this two assets makes it a promising tool for real time transcranial pressure field prediction during ultrasound brain therapy interventions.

In Vivo Measurement of Brain Tumor Elasticity Using Intraoperative Shear Wave Elastography

Purpose: Objective Shear wave elastography (SWE) enabled living tissue assessment of stiffness. This is routinely used for breast, thyroid and liver diseases, but there is currently no data for the brain. We aim to characterize elasticity of normal brain parenchyma and brain tumors using SWE. Materials and Methods: Patients with scheduled brain tumor removal were included in this study. In addition to standard ultrasonography, intraoperative SWE using an ultrafast ultrasonic device was used to measure the elasticity of each tumor and its surrounding normal brain. Data were collected by an investigator blinded to the diagnosis. Descriptive statistics, box plot analysis as well as intraoperator and interoperator reproducibility analysis were also performed. Results: 63 patients were included and classified into four main types of tumor: meningiomas, low-grade gliomas, high-grade gliomas and metastasis. Young's Modulus measured by SWE has given new insight to differentiate brain tumors: 33.1 ± 5.9 kPa, 23.7 ± 4.9 kPa, 11.4 ± 3.6 kPa and 16.7 ± 2.5 kPa, respectively, for the four subgroups. Normal brain tissue has been characterized by a reproducible mean stiffness of 7.3 ± 2.1 kPa. Moreover, low-grade glioma stiffness is different from high-grade glioma stiffness (p = 0.01) and normal brain stiffness is very different from low-grade gliomas stiffness (p < 0.01). Conclusion: This study demonstrates that there are significant differences in elasticity among the most common types of brain tumors. With intraoperative SWE, neurosurgeons may have innovative information to predict diagnosis and guide their resection.

Muscle parameters estimation based on biplanar radiography

The evaluation of muscle and joint forces in vivo is still a challenge. Musculo-Skeletal (musculo-skeletal) models are used to compute forces based on movement analysis. Most of them are built from a scaled-generic model based on cadaver measurements, which provides a low level of personalization, or from Magnetic Resonance Images, which provide a personalized model in lying position. This study proposed an original two steps method to access a subject-specific musculo-skeletal model in 30 min, which is based solely on biplanar X-Rays. First, the subject-specific 3D geometry of bones and skin envelopes were reconstructed from biplanar X-Rays radiography. Then, 2200 corresponding control points were identified between a reference model and the subject-specific X-Rays model. Finally, the shape of 21 lower limb muscles was estimated using a non-linear transformation between the control points in order to fit the muscle shape of the reference model to the X-Rays model. Twelfth musculo-skeletal models were reconstructed and compared to their reference. The muscle volume was not accurately estimated with a standard deviation (SD) ranging from 10 to 68%. However, this method provided an accurate estimation the muscle line of action with a SD of the length difference lower than 2% and a positioning error lower than 20 mm. The moment arm was also well estimated with SD lower than 15% for most muscle, which was significantly better than scaled-generic model for most muscle. This method open the way to a quick modeling method for gait analysis based on biplanar radiography.

In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis

The shear wave velocity dispersion was analyzed in the Achilles tendon (AT) during passive dorsiflexion using a phase velocity method in order to obtain the tendon shear modulus (C 55). Based on this analysis, the aims of the present study were (i) to assess the reproducibility of the shear modulus for different ankle angles, (ii) to assess the effect of the probe locations, and (iii) to compare results with elasticity values obtained with the supersonic shear imaging (SSI) technique. The AT shear modulus (C 55) consistently increased with the ankle dorsiflexion (N = 10, p < 0.05). Furthermore, the technique showed a very good reproducibility (all standard error of the mean values <10.7 kPa and all coefficient of variation (CV) values ⩽ 0.05%). In addition, independently from the ankle dorsiflexion, the shear modulus was significantly higher in the proximal location compared to the more distal one. The shear modulus provided by SSI was always lower than C55 and the difference increased with the ankle dorsiflexion. However, shear modulus values provided by both methods were highly correlated (R = 0.84), indicating that the conventional shear wave elastography technique (SSI technique) can be used to compare tendon mechanical properties across populations. Future studies should determine the clinical relevance of the shear wave dispersion analysis, for instance in the case of tendinopathy or tendon tear.

Placental elastography in a murine intrauterine growth restriction model

OBJECTIVE

To compare placental elasticity in normal versus intrauterine growth restriction (IUGR) murine pregnancies using shear wave elastography (SWE).

METHODS

Intrauterine growth restriction was created by ligation of the left uterine artery of Sprague-Dawley rats on E17. Ultrasonography (US) and elastography were performed 2 days later on exteriorized horns after laparotomy. Biparietal diameter (BPD) and abdominal diameter (AD) were measured and compared in each horn. Placental elasticity of each placenta was compared in the right and left horns, respectively, using the Young's modulus, which increases with increasing stiffness of the tissue.

RESULTS

Two hundred seventeen feto-placental units from 18 rats were included. Fetuses in the left ligated horn had smaller biometric measurements than those in the right horn (6.7 vs 7.2 mm, p < 0.001, and 9.2 vs 11.2 mm, p < 0.001 for BPD and AD, respectively). Mean fetal weight was lower in the pups from the left than the right horn (1.65 vs 2.11 g; p < 0.001). Mean (SD) Young's modulus was higher for placentas from the left than the right horn (11.7 ± 1.5 kPa vs 8.01 ± 3.8 kPa, respectively; p < 0.001), indicating increased stiffness in placentas from the left than the right horn. There was an inverse relationship between fetal weight and placental elasticity (r = 0.42; p < 0.001).

CONCLUSION

Shear wave elastography may be used to provide quantitative elasticity measurements of the placenta. In our model, placentas from IUGR fetuses demonstrated greater stiffness, which correlated with the degree of fetal growth restriction.

In vivo evaluation of the elastic anisotropy of the human Achilles tendon using shear wave dispersion analysis

Non-invasive evaluation of the Achilles tendon elastic properties may enhance diagnosis of tendon injury and the assessment of recovery treatments. Shear wave elastography has shown to be a powerful tool to estimate tissue mechanical properties. However, its applicability to quantitatively evaluate tendon stiffness is limited by the understanding of the physics on the shear wave propagation in such a complex medium. First, tendon tissue is transverse isotropic. Second, tendons are characterized by a marked stiffness in the 400 to 1300 kPa range (i.e. fast shear waves). Hence, the shear wavelengths are greater than the tendon thickness leading to guided wave propagation. Thus, to better understand shear wave propagation in tendons and consequently to properly estimate its mechanical properties, a dispersion analysis is required. In this study, shear wave velocity dispersion was measured in vivo in ten Achilles tendons parallel and perpendicular to the tendon fibre orientation. By modelling the tendon as a transverse isotropic viscoelastic plate immersed in fluid it was possible to fully describe the experimental data (deviation<1.4%). We show that parallel to fibres the shear wave velocity dispersion is not influenced by viscosity, while it is perpendicularly to fibres. Elasticity (found to be in the range from 473 to 1537 kPa) and viscosity (found to be in the range from 1.7 to 4 Pa.s) values were retrieved from the model in good agreement with reported results.

Effects of storage temperature on the mechanical properties of porcine kidney estimated using shear wave elastography

The objective of this study was to evaluate the effects of different conservation techniques on the mechanical properties of the ex vivo porcine kidney in order to select an appropriate conservation protocol to use prior to mechanical testing. Five groups of eight kidneys each were subjected to different methods of conservation: storage at 4°C, -18°C, -34°C and -71°C, for 7 days, or storage at 20°C for 2 days only (as the tissues degraded quickly). Their shear modulus as a function of depth in the organ was evaluated before (fresh) and after conservation using shear wave elastography. Results obtained on fresh kidneys were collected within 6h of death. Freezing lead to a significant decrease (p<0.05) of the shear modulus in the most superficial zone (renal cortex), irrespectively of the freezing temperature (-18°C, -34°C, -71°C). There were no significant change (p>0.05) in the properties of the renal cortex when stored at 4°C or 20°C. The average moduli in the central region of the kidney (medulla) were much higher than in the cortex and exhibited also exhibited larger specimen to specimen variations. The effects of the conservation method on the central region were not significant. Overall, the results suggest that kidney tissues should not be frozen prior to biomechanical characterization and that inhomogeneity may be important to consider for in biomechanical models.

Ultrasound elastography: principles and techniques

Ultrasonography has been widely used for diagnosis since it was first introduced in clinical practice in the 1970's. Since then, new ultrasound modalities have been developed, such as Doppler imaging, which provides new information for diagnosis. Elastography was developed in the 1990's to map tissue stiffness, and reproduces/replaces the palpation performed by clinicians. In this paper, we introduce the principles of elastography and give a technical summary for the main elastography techniques: from quasi-static methods that require a static compression of the tissue to dynamic methods that uses the propagation of mechanical waves in the body. Several dynamic methods are discussed: vibro-acoustography, Acoustic Radiation Force Impulsion (ARFI), transient elastography, shear wave imaging, etc. This paper aims to help the reader at understanding the differences between the different methods of this promising imaging modality that may become a significant tool in medical imaging.

Renal ultrasound elastography

Chronic kidney disease (CKD) incidence and prevalence are increasing in Western countries, due particularly to diabetes mellitus and hypertension-related nephropathies. CKD may lead to end-stage renal failure, with extensive morbidity, mortality and increasing health costs. Primary and secondary prevention requires a better knowledge of mechanisms underlying renal scarring, the development of specific therapies to slow down the progression of the disease and the development of non-invasive diagnostic tools to characterize the process. Ultrasound elastography is a new imaging technique under development that provides information about renal stiffness. Kidney elasticity measurements with ultrasound should be performed with a quantitative technique, such as Shearwave techniques. However kidney stiffness is not only related to fibrosis, as it also sensitive to mechanical and functional parameters such as anisotropy, vascularization, hydronephrosis and external pressure. This paper reviews the existing ultrasound elastography techniques. Elastography is a new tool under development for renal tissue characterization and needs further validation in clinical practice.

Acoustoelasticity in soft solids: assessment of the nonlinear shear modulus with the acoustic radiation force

The assessment of viscoelastic properties of soft tissues is enjoying a growing interest in the field of medical imaging as pathologies are often correlated with a local change of stiffness. To date, advanced techniques in that field have been concentrating on the estimation of the second order elastic modulus (mu). In this paper, the nonlinear behavior of quasi-incompressible soft solids is investigated using the supersonic shear imaging technique based on the remote generation of polarized plane shear waves in tissues induced by the acoustic radiation force. Applying a theoretical approach of the strain energy in soft solid [Hamilton et al., J. Acoust. Soc. Am. 116, 41-44 (2004)], it is shown that the well-known acoustoelasticity experiment allowing the recovery of higher order elastic moduli can be greatly simplified. Experimentally, it requires measurements of the local speed of polarized plane shear waves in a statically and uniaxially stressed isotropic medium. These shear wave speed estimates are obtained by imaging the shear wave propagation in soft media with an ultrafast echographic scanner. In this situation, the uniaxial static stress induces anisotropy due to the nonlinear effects and results in a change of shear wave speed. Then the third order elastic modulus (A) is measured in agar-gelatin-based phantoms and polyvinyl alcohol based phantoms.

Measuring of viscoelastic properties of homogeneous soft solid using transient elastography: an inverse problem approach

Two main questions are at the center of this paper. The first one concerns the choice of a rheological model in the frequency range of transient elastography, sonoelasticity or NMR elastography for soft solids (20-1000 Hz). Transient elastography experiments based on plane shear waves that propagate in an Agar-gelatin phantom or in bovine muscles enable one to quantify their viscoelastic properties. The comparison of these experimental results to the prediction of the two simplest rheological models indicate clearly that Voigt's model is the better. The second question studied in the paper deals with the feasibility of quantitative viscosity mapping using inverse problem algorithm. In the ideal situation where plane shear waves propagate in a sample, a simple inverse problem based on the Helmholtz equation correctly retrieves both elasticity and viscosity. In a more realistic situation with nonplane shear waves, this simple approach fails. Nevertheless, it is shown that quantitative viscosity mapping is still possible if one uses an appropriate inverse problem that fully takes into account diffraction in solids.

Measurement of elastic nonlinearity of soft solid with transient elastography

Transient elastography is a powerful tool to measure the speed of low-frequency shear waves in soft tissues and thus to determine the second-order elastic modulus mu (or the Young's modulus E). In this paper, it is shown how transient elastography can also achieve the measurement of the nonlinear third-order elastic moduli of an Agar-gelatin-based phantom. This method requires speed measurements of polarized elastic waves measured in a statically stressed isotropic medium. A static uniaxial stress induces a hexagonal anisotropy (transverse isotropy) in solids. In the special case of uniaxially stressed isotropic media, the anisotropy is not caused by linear elastic coefficients but by the third-order nonlinear elastic constants, and the medium recovers its isotropic properties as soon as the uniaxial stress disappears. It has already been shown how transient elastography can measure the elastic (second-order) moduli in a media with transverse isotropy such as muscles. Consequently this method, based on the measurement of the speed variations of a low-frequency (50-Hz) polarized shear strain waves as a function of the applied stress, allows one to measure the Landau moduli A, B, C that completely describe the third-order nonlinearity. The several orders of magnitude found among these three constants can be justified from the theoretical expression of the internal energy.

Observation of shock transverse waves in elastic media

We report the first experimental observation of a shock transverse wave propagating in an elastic medium. This observation was possible because the propagation medium, a soft solid, allows one to reach a very high Mach number. In this extreme configuration, the shock formation is observed over a distance of less than a few wavelengths, thanks to a prototype of an ultrafast scanner (that acquires 5000 frames per second). A comparison of these new experimental data with theoretical predictions, based on a modified Burger's equation, shows good agreement.

In vivo breast tumor detection using transient elastography

This paper presents first in vivo experiments for breast tumor detection using transient elastography. This technique has been developed for detection and quantitative mapping of hard lesions in soft tissues. It consists in following the propagation inside soft tissues of very low-frequency shear waves (approximately 60 Hz) generated by a vibrating system located at the body surface. Because transient shear waves propagate through the medium in less than 0.1 s, the shear propagation imaging is performed with an ultrafast echographic scanner able to reach frame rates up to 6000 Hz. The local shear wave speed is directly linked to the local shear Young's modulus of the medium. The shear elasticity map of the medium can then be computed using an inversion algorithm. In vivo experiments were conducted on 15 women who had palpable breast lesions. For clinical adaptability reasons, shear waves were generated by the surface of the ultrasound (US) imaging transducer itself, which was linked to a mechanical vibrator. Our preliminary in vivo results demonstrate the clinical applicability of the transient elastography technique for breast lesion detection.