Laurent Sandrin

Shear modulus imaging with 2-D transient elastography

In previous work, we have shown that time-resolved 2-D transient elastography is a promising technique for characterizing the elasticity of soft tissues. It involves the measurement of the displacements induced by the propagation of low frequency (LF) pulsed shear waves in biological tissues. In this paper, we present a novel apparatus that contains a LF vibrating device surrounding a linear array of 128 ultrasonic transducers that performs ultrafast ultrasonic imaging (up to 10,000 frames/s) and that is able to follow in real time the propagation of a LF shear wave in the human body. The vibrating device is made of two rods, fixed to electromagnetic vibrators, that produce in the ultrasonic image area a large amplitude shear wave. The geometry has been chosen both to enhance the sensitivity and to create a quasi linear shear wave front in the imaging plane. An inversion algorithm is used to recover the shear modulus map from the spatio-temporal data, and the first experimental results obtained from tissue-equivalent materials are presented.

Shear elasticity probe for soft tissues with 1-D transient elastography

Important tissue parameters such as elasticity can be deduced from the study of the propagation of low frequency shear waves. A new method for measuring the shear velocity in soft tissues is presented in this paper. Unlike conventional transient elastography in which the ultrasonic transducer and the low frequency vibrator are two separated parts, the new method relies on a probe that associates the vibrator and the transducer, which is built on the axis of the vibrator. This setup is easy to use. The low frequency shear wave is driven by the transducer itself that acts as a piston while it is used in pulse echo mode to acquire ultrasonic lines. The results obtained with the new method are in good agreement with those obtained with the conventional one.

Controlled attenuation parameter (CAP): a novel VCTE™ guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes.

There is a need for noninvasive methods to detect liver steatosis, which can be a factor of liver fibrosis progression. This work aims to evaluate a novel ultrasonic controlled attenuation parameter (CAP) devised to target, specifically, liver steatosis using a sophisticated process based on vibration control transient elastography (VCTE™). CAP was first validated as an estimate of ultrasonic attenuation at 3.5 MHz using Field II simulations and tissue-mimicking phantoms. Performance of the CAP was then appraised on 115 patients, taking the histological grade of steatosis as reference. CAP was significantly correlated to steatosis (Spearman ρ = 0.81, p < 10(-16)). Area under receiver operative characteristic (ROC) curve (AUC) was equal to 0.91 and 0.95 for the detection of more than 10% and 33% of steatosis, respectively. Furthermore, results show that CAP can efficiently separate several steatosis grades. These promising results suggest that CAP is a noninvasive, immediate, objective and efficient method to detect and quantify steatosis.

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 Youngs 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.

Time-resolved pulsed elastography with ultrafast ultrasonic imaging.

In this paper, a new elastographic method is proposed. Using this method, the propagation of a low-frequency transient shear wave can be imaged by means of an ultrafast imaging system (up to 10,000 frames/s) that we have developed. Ultrafast ultrasonic imaging is obtained with a linear array of transducers (3.5 MHz) connected to electronics that have 64 channels sampled at 30 MHz and 128 Kbytes for storing the backscattered signals. Displacements are measured using cross-correlation of the ultrasonic signals. Movies of the low central frequency (200 Hz) shear wave propagation through homogeneous and heterogeneous phantoms have been obtained with 1,000 and 2,000 frames per second.

Assessment of elastic parameters of human skin using dynamic elastography

Sonoelastography and transient elastography are two ultrasound-based techniques that facilitate noninvasive characterization of the viscoelastic properties of soft tissues by investigating their response to shear mechanical excitation. Youngs modulus is the principle assessment parameter. Because it defines local tissue stiffness, it is of major interest for the medical imaging and cosmetic industries as it could replace subjective palpation by yielding local, quantitative information. In this paper, we describe a new high-resolution device capable of measuring local Youngs modulus in very thin layers (1-5 mm) and devoted to the in vivo evaluation of the elastic properties of human skin. It uses an ultrasonic probe (50 MHz) for tracking the displacements induced by a 300 Hz shear wave generated by a ring surrounding the transducer. The displacements are measured using a conventional cross-correlation technique between successive ultrasonic back-scattered echoes. First, this noninvasive technique has been experimentally proven to be accurate for investigating elasticity in different skin-mimicking phantoms. Second, data were acquired in vivo on human forearms. As expected, Youngs modulus was found to be higher in the dermis than in the hypodermis and other soft tissues.

Liver stiffness: a novel parameter for the diagnosis of liver disease

The noninvasive quantitation of liver stiffness (LS) by ultrasound based transient elastography using FibroScan® has revolutionized the diagnosis of liver diseases, namely liver cirrhosis. Alternative techniques such as acoustic radiation impulse frequency imaging or magnetic resonance elastography are currently under investigation. LS is an excellent surrogate marker of advanced fibrosis (F3) and cirrhosis (F4) outscoring all previous noninvasive approaches to detect cirrhosis. LS values below 6 kPa are considered as normal and exclude ongoing liver disease. LS of 8 and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis. LS highly correlates with portal pressure, and esophageal varices are likely at values >20 kPa. Many other factors may also increase LS such as hepatic infiltration with tumor cells, mast cells (mastocytosis), inflammatory cells (all forms of hepatitis) or amyloidosis. In addition, LS is directly correlated with the venous pressure (eg, during liver congestion) and is increased during mechanic cholestasis. Thus, LS should always be interpreted in the context of clinical, imaging and laboratory findings. Finally, LS has helped to better understand the molecular mechanisms underlying liver fibrosis. The novel pressure-stiffness-fibrosis sequence hypothesis is introduced.

The role of the coupling term in transient elastography

The transient radiation of low-frequency elastic waves through isotropic and homogeneous soft media is investigated using the Greens function approach. A careful analysis of the coupling term is performed and yields the introduction of a very near field region in which its amplitude behaves as 1/r. To address the calculation of impulse responses, a simplified Greens function is proposed for semi-infinite media and compared to exact solutions. Impulse response calculations are successfully compared with experimental measurements obtained for circular radiators of different diameters using transient elastography. Results presented in this paper provide a better understanding of the role of the coupling term in elastography and should be used to compensate diffraction and coupling effects observed in transient elastography.

Cross-validation of magnetic resonance elastography and ultrasound-based transient elastography: A preliminary phantom study

To cross‐validate two recent noninvasive elastographic techniques, ultrasound‐based transient elastography (UTE) and magnetic resonance elastography (MRE). As potential alternatives to liver biopsy, UTE and MRE are undergoing clinical investigations for liver fibrosis diagnosis and liver disease management around the world. These two techniques use tissue stiffness as a marker for disease state and it is important to do a cross‐validation study of both elastographic techniques to determine the consistency with which the two techniques can measure the mechanical properties of materials.

RSNA/QIBA: Shear wave speed as a biomarker for liver fibrosis staging

An interlaboratory study of shear wave speed (SWS) estimation was performed. Commercial shear wave elastography systems from Fibroscan, Philips, Siemens and Supersonic Imagine, as well as several custom laboratory systems, were involved. Fifteen sites were included in the study. CIRS manufactured and donated 11 pairs of custom phantoms designed for the purposes of this investigation. Dynamic mechanical tests of equivalent phantom materials were also performed. The results of this study demonstrate that there is very good agreement among SWS estimation systems, but there are several sources of bias and variance that can be addressed to improve consistency of measurement results.