Azra Alizad

Vibro-acoustic tissue mammography

A novel method for detection and imaging of microcalcifications in breast tissue is presented. The method, called vibro-acoustography, uses the radiation force of ultrasound to vibrate tissue at low (kHz) frequency and utilizes the resulting response to produce images that are related to the hardness of the tissue. The method is tested on human breast tissues. The resulting vibro-acoustographic images are in agreement with corresponding X-ray mammography images of the specimens. The existence of microcalcifications in locations indicated by vibro-acoustography is confirmed by histology. Microcalcifications as small as 110 /spl mu/m in diameter are detected by this method. Resulting vibro-acoustographic images show microcalcifications with high contrast with respect to the background soft tissue. Structures such as dense sclerotic tissue do not seem to interfere with detection of microcalcifications.

Performance of vibro-acoustography in detecting microcalcifications in excised human breast tissue: a study of 74 tissue samples

X-ray mammography is the principal modality used today for detection of breast microcalcifications and breast lesions associated with breast cancer. X-ray mammography, however, is ionizing and its sensitivity is greatly reduced in dense breasts. Hence, alternative noninvasive and nonionizing breast imaging tools that can aid physicians to better diagnose early-stage breast lesions are of great interest. Vibro-acoustography is a novel noninvasive imaging technique that uses ultrasound in a fundamentally new way. This method uses the radiation force of ultrasound to vibrate the tissue at low (kilohertz) frequency and records the resulting response to produce images that are related to the mechanical properties of the tissue. The goal of this study is to evaluate the performance of vibro-acoustography in detecting breast microcalcifications by conducting vibro-acoustography on 74 fixed breast tissue samples with known microcalcifications based on their radiographs. The results indicate that in most cases micro-calcifications can be detected by vibro-acoustography. Further development of vibro-acoustography may lead to a novel-imaging tool for in vivo detection of microcalcifications.

Potential applications of vibro-acoustography in breast imaging.

Vibro-acoustography has gained interest in the recent years as a new modality for medical imaging. This method is based on low-frequency vibrations induced in the object by the radiation force of ultrasound. This paper focuses on potential applications of vibro-acoustography in breast imaging, including detection of microcalcifications, detection of arterial calcifications, and soft tissue imaging. In addition, we will briefly discuss our recent results of in vivo breast vibro-acoustography. Future developments and potential impact of vibro-acoustography in breast imaging are also discussed.

A Review of Vibro-acoustography and its Applications in Medicine.

In recent years, several new techniques based on the radiation force of ultrasound have been developed. Vibro-acoustography is a speckle-free ultrasound based imaging modality that can visualize normal and abnormal soft tissue through mapping the acoustic response of the object to a harmonic radiation force induced by ultrasound. In vibro-acoustography, the ultrasound energy is converted from high ultrasound frequencies to a low acoustic frequency (acoustic emission) that is often two orders of magnitude smaller than the ultrasound frequency. The acoustic emission is normally detected by a hydrophone. In medical imaging, vibroacoustography has been tested on breast, prostate, arteries, liver, and thyroid. These studies have shown that vibro-acoustic data can be used for quantitative evaluation of elastic properties. This paper presents an overview of vibro-acoustography and its applications in the areas of biomedicine.

Application of Vibro-acoustography for Detection of Calcified Arteries in Breast Tissue

Objective. The relationship between breast arterial calcification and coronary artery calcification and stenosis is currently an area of active research. It has been suggested in the literature that calcified arteries in the breast may be positively correlated with coronary artery disease. The sensitivity of x‐ray mammography, the main breast imaging method, is reduced in radiologically dense breasts. In a recent study, we showed that vibro‐acoustography, a novel noninvasive imaging technique that is based on the dynamic response of the object to a vibrating force, can detect microcalcifications in the breast regardless of breast density. In this study, we examined the application of vibro‐acoustography in detecting calcified arteries in breast tissue. Methods. Experiments were conducted on 207 postsurgical excised human breast tissue samples. Tissues specimens were imaged with a high‐resolution x‐ray mammography unit. Each sample with confirmed arterial calcification was then scanned by the vibro‐acoustography system, and the resulting image was compared with the corresponding mammogram. We also studied the histologic characteristics of each sample to positively identify the disease and the presence of arterial calcification. Results. Initial mammograms clearly showed 14 calcified arteries. The corresponding vibro‐acoustographic images showed all calcified arteries as fragmented linear structures. The vibro‐acoustographic appearance of the arteries was highly correlated with their distinctive radiographic appearance, which allowed us to identify all the calcified arteries in the vibro‐acoustographic images. Conclusions. Vibro‐acoustography can be used to detect calcified arteries in excised breast tissue. This method may eventually play a role in identifying individuals with an increased risk of coronary artery disease.

Prostate Cryotherapy Monitoring Using Vibroacoustography: Preliminary Results of an Ex Vivo Study and Technical Feasibility

The objective of this research is to prospectively evaluate the feasibility of vibroacoustography (VA) imaging in monitoring prostate cryotherapy in an ex vivo model. Baseline scanning of an excised human prostate is accomplished by a VA system apparatus in a tank of degassed water. Alcohol and dry ice mixture are used to freeze two prostate tissue samples. The frozen prostates are subsequently placed within the water tank at 27degC and rescanned. VA images were acquired at prescribed time intervals to characterize the acoustic properties of the partially frozen tissue. The frozen prostate tissue appears in the images as hypoemitting signal. Once the tissue thaws, previously frozen regions show coarser texture than prior to freezing. The margin of the frozen tissue is delineated with a well-defined rim. The thawed cryolesions show a different contrast compared with normal unfrozen prostate. In conclusion, this pilot study shows that VA produces clear images of a frozen prostate at different temperature stages. The frozen tissue appears as a uniform region with well-defined borders that are readily identified. These characteristic images should allow safer and more efficient application of prostatic cryosurgery. These results provide substantial motivation to further investigate VA as a potential modality to monitor prostate cryotherapy intraoperatively.

Two-dimensional shear-wave elastography on conventional ultrasound scanners with time-aligned sequential tracking (TAST) and comb-push ultrasound shear elastography (CUSE)

Two-dimensional shear-wave elastography presents 2-D quantitative shear elasticity maps of tissue, which are clinically useful for both focal lesion detection and diffuse disease diagnosis. Realization of 2-D shear-wave elastography on conventional ultrasound scanners, however, is challenging because of the low tracking pulse-repetition-frequency (PRF) of these systems. Although some clinical and research platforms support software beamforming and plane-wave imaging with high PRF, the majority of current clinical ultrasound systems do not have the software beamforming capability, which presents a critical challenge for translating the 2-D shear-wave elastography technique from laboratory to clinical scanners. To address this challenge, this paper presents a time-aligned sequential tracking (TAST) method for shear-wave tracking on conventional ultrasound scanners. TAST takes advantage of the parallel beamforming capability of conventional systems and realizes high-PRF shear-wave tracking by sequentially firing tracking vectors and aligning shear wave data in the temporal direction. The comb-push ultrasound shear elastography (CUSE) technique was used to simultaneously produce multiple shear wave sources within the field-of-view (FOV) to enhance shear wave SNR and facilitate robust reconstructions of 2-D elasticity maps. TAST and CUSE were realized on a conventional ultrasound scanner. A phantom study showed that the shear-wave speed measurements from the conventional ultrasound scanner were in good agreement with the values measured from other 2-D shear wave imaging technologies. An inclusion phantom study showed that the conventional ultrasound scanner had comparable performance to a state-of-the-art shear-wave imaging system in terms of bias and precision in measuring different sized inclusions. Finally, in vivo case analysis of a breast with a malignant mass, and a liver from a healthy subject demonstrated the feasibility of using the conventional ultrasound scanner for in vivo 2-D shear-wave elastography. These promising results indicate that the proposed technique can enable the implementation of 2-D shear-wave elastography on conventional ultrasound scanners and potentially facilitate wider clinical applications with shear-wave elastography.

Echocardiographic Features of Genetic Diseases: Part 1. Cardiomyopathy

Introduction To The Series Genetic disorders have characteristic cardiovascular manifestations. These cardiovascular abnormalities often are a major determinant of the morbidity and mortality in this patient population. Some characteristics are unique and can be detected with echocardiography. Drs Alizad and Seward have compiled in this series a review of genetic disorders that have recognizable morphologic and/or functional cardiovascular abnormalities. The following topics will be explored, with examples from the database of the Mayo Clinic Echocardiography Laboratory:Cardiomyopathy Storage disease Shunts Connective tissue Tumors Complex cardiovascular defects Complex genetic disorders Organ system

Vibro-acoustography imaging of permanent prostate brachytherapy seeds in an excised human prostate--preliminary results and technical feasibility.

OBJECTIVE The objective in this work is to investigate the feasibility of using a new imaging tool called vibro-acoustography (VA) as a means of permanent prostate brachytherapy (PPB) seed localization to facilitate post-implant dosimetry (PID). METHODS AND MATERIALS Twelve OncoSeed (standard) and eleven EchoSeed (echogenic) dummy seeds were implanted in a human cadaver prostate. Seventeen seeds remained after radical retropubic prostatectomy. VA imaging was conducted on the prostate that was cast in a gel phantom and placed in a tank of degassed water. 2-D magnitude and phase VA image slices were obtained at different depths within the prostate showing location and orientation of the seeds. RESULTS VA demonstrates that twelve of seventeen (71%) seeds implanted were visible in the VA image, and the remainder were obscured by intra-prostatic calcifications. Moreover, it is shown here that VA is capable of imaging and locating PPB seeds within the prostate independent of seed orientation, and the resulting images are speckle free. CONCLUSION The results presented in this research show that VA allows seed detection within a human prostate regardless of their orientation, as well as imaging intra-prostatic calcifications.

Comb-Push Ultrasound Shear Elastography (CUSE) for Evaluation of Thyroid Nodules: Preliminary In Vivo Results

In clinical practice, an overwhelming majority of biopsied thyroid nodules are benign. Therefore, there is a need for a complementary and noninvasive imaging tool to provide clinically relevant diagnostic information about thyroid nodules to reduce the rate of unnecessary biopsies. The goal of this study was to evaluate the feasibility of utilizing comb-push ultrasound shear elastography (CUSE) to measure the mechanical properties (i.e., stiffness) of thyroid nodules and use this information to help classify nodules as benign or malignant. CUSE is a fast and robust 2-D shear elastography technique in which multiple laterally distributed acoustic radiation force beams are utilized simultaneously to produce shear waves. Unlike other shear elasticity imaging modalities, CUSE does not suffer from limited field of view (FOV) due to shear wave attenuation and can provide a large FOV at high frame rates. To evaluate the utility of CUSE in thyroid imaging, a preliminary study was performed on a group of five healthy volunteers and 10 patients with ultrasound-detected thyroid nodules prior to fine needle aspiration biopsy. The measured shear wave speeds in normal thyroid tissue and thyroid nodules were converted to Youngs modulus (E), indicating a measure of tissue stiffness. Our results indicate an increase in E for thyroid nodules compared to normal thyroid tissue. This increase was significantly higher in malignant nodules compared to benign. The Youngs modulus in normal thyroid tissue, benign and malignant nodules were found to be 23.2 ±8.29 kPa, 91.2±34.8 kPa, and 173.0±17.1 kPa, respectively. Results of this study suggest the utility of CUSE in differentiating between benign and malignant thyroid nodules.