Marvin M. Doyley

Imaging the elastic properties of tissue: the 20 year perspective

After 20 years of innovation in techniques that specifically image the biomechanical properties of tissue, the evolution of elastographic imaging can be viewed from its infancy, through a proliferation of approaches to the problem to incorporation on research and then clinical imaging platforms. Ultimately this activity has culminated in clinical trials and improved care for patients. This remarkable progression represents a leading example of translational research that begins with fundamentals of science and engineering and progresses to needed improvements in diagnostic and monitoring capabilities applied to major categories of disease, surgery and interventional procedures. This review summarizes the fundamental principles, the timeline of developments in major categories of elastographic imaging, and concludes with recent results from clinical trials and forward-looking issues.

Evaluation of an iterative reconstruction method for quantitative elastography

This paper describes an inverse reconstruction technique based on a modified Newton Raphson iterative scheme and the finite element method, which has been developed for computing the spatial distribution of Youngs modulus from within soft tissues. Computer simulations were conducted to determine the relative merits of reconstructing tissue elasticity using knowledge of (a) known displacement boundary conditions (DBC), and (b) known stress boundary conditions (SBC). The results demonstrated that computing Youngs modulus using knowledge of SBC allows accurate quantification of Youngs modulus. However, the quality of the images produced using this reconstruction approach was dependent on the Youngs modulus distribution assumed at the start of the reconstruction procedure. Computing Youngs modulus from known DBC provided relative estimates of tissue elasticity which, despite the disadvantage of not being able to accurately quantify Youngs modulus, formed images that were generally superior in quality to those produced using the known SBC, and were not affected by the trial solution. The results of preliminary experiments on phantoms demonstrated that this reconstruction technique is capable in practice of improving the fidelity of tissue elasticity images, reducing the artefacts otherwise present in strain images, and recovering Youngs modulus images that possess excellent spatial and contrast resolution.

Automated region detection based on the contrast-to-noise ratio in near-infrared tomography

The contrast-to-noise ratio (CNR) was used to determine the detectability of objects within reconstructed images from diffuse near-infrared tomography. It was concluded that there was a maximal value of CNR near the location of an object within the image and that the size of the true region could be estimated from the CNR. Experimental and simulation studies led to the conclusion that objects can be automatically detected with CNR analysis and that our current system has a spatial resolution limit near 4 mm and a contrast resolution limit near 1.4. A new linear convolution method of CNR calculation was developed for automated region of interest (ROI) detection.

A freehand elastographic imaging approach for clinical breast imaging: system development and performance evaluation

A prototype freehand elastographic imaging system has been developed for clinical breast imaging. The system consists of a fast data acquisition system, which is able to capture sequences of intermediate frequency echo frames at full frame rate from a commercial ultrasound scanner whilst the breast is deformed using hand-induced transducer motion. Two-dimensional echo tracking was used in combination with global distortion compensation and multi-compression averaging to minimise decorrelation noise incurred when stress is applied using hand-induced transducer motion. Experiments were conducted on gelatine phantoms to evaluate the quality of elastograms produced using the prototype system relative to those produced using mechanically induced transducer motion. The strain sensitivity and contrast-to-noise ratio of freehand elastograms compared favourably with elastograms produced using mechanically induced transducer motion. However, better dynamic range and signal-to-noise ratio was achieved when elastograms were created using mechanically induced transducer motion. Despite the loss in performance incurred when stress is applied using hand-induced transducer motion, it was concluded that the prototype system performed sufficiently well to warrant clinical evaluation.

Model-based elastography: a survey of approaches to the inverse elasticity problem

Elastography is emerging as an imaging modality that can distinguish normal versus diseased tissues via their biomechanical properties. This paper reviews current approaches to elastography in three areas--quasi-static, harmonic and transient--and describes inversion schemes for each elastographic imaging approach. Approaches include first-order approximation methods; direct and iterative inversion schemes for linear elastic; isotropic materials and advanced reconstruction methods for recovering parameters that characterize complex mechanical behavior. The papers objective is to document efforts to develop elastography within the framework of solving an inverse problem, so that elastography may provide reliable estimates of shear modulus and other mechanical parameters. We discuss issues that must be addressed if model-based elastography is to become the prevailing approach to quasi-static, harmonic and transient elastography: (1) developing practical techniques to transform the ill-posed problem with a well-posed one; (2) devising better forward models to capture the complex mechanical behavior of soft tissues and (3) developing better test procedures to evaluate the performance of modulus elastograms.

Evaluation of the adjoint equation based algorithm for elasticity imaging.

Recently a new adjoint equation based iterative method was proposed for evaluating the spatial distribution of the elastic modulus of tissue based on the knowledge of its displacement field under a deformation. In this method the original problem was reformulated as a minimization problem, and a gradient-based optimization algorithm was used to solve it. Significant computational savings were realized by utilizing the solution of the adjoint elasticity equations in calculating the gradient. In this paper, we examine the performance of this method with regard to measures which we believe will impact its eventual clinical use. In particular, we evaluate its abilities to (1) resolve geometrically the complex regions of elevated stiffness; (2) to handle noise levels inherent in typical instrumentation; and (3) to generate three-dimensional elasticity images. For our tests we utilize both synthetic and experimental displacement data, and consider both qualitative and quantitative measures of performance. We conclude that the method is robust and accurate, and a good candidate for clinical application because of its computational speed and efficiency.

Magnetic resonance-guided near-infrared tomography of the breast

The design and implementation of a multispectral, frequency-domain near infrared tomography system is outlined, which operates in a MRI magnet for utilization of MR-guided image reconstruction of tissue optical properties. Using long silica optical fiber bundles, measurements of light transmission through up to 12 cm of female breast tissue can be acquired simultaneously with MRI scans. The NIR system utilizes six optical wavelengths from 660 to 850 nm using intensity modulated diode lasers nominally working at 100 MHz. Photomultiplier tube detector gain levels are electronically controlled on a time scale of 200 ms, thereby allowing rapid switching of the source to locations around the tissue. There are no moving parts in the detection channels and for each source position, 15 PMTs operating in parallel allow sensitivity down to 0.5 pW/cm2 at the tissue surface. Images of breast tissue optical absorption and reduced scattering coefficients are obtained using a Newton-type reconstruction algorithm to solv...

Strain imaging using combined RF and envelope autocorrelation processing

Considering that large displacements are desired for elasticity imaging to improve the strain signal to noise ratio, the authors have developed a method for strain imaging that is both fast to calculate and applicable to the measurement of large displacements. The method has the merits of phase domain processing but without aliasing, since it combines the result of phase correlation with that of envelope correlation both of which are calculated directly from the radio frequency (RF) signal using complex autocorrelation processing. Results from experiments using a computer simulation indicate that the method is capable of reliably estimating tissue displacement and strain over a large range of displacements beyond the Doppler aliasing limit with no prior knowledge of expected displacement.

Advancing intravascular ultrasonic palpation toward clinical applications

This paper describes the first reported attempt to develop a real-time intravascular ultrasonic palpation system. We also report on our first experience in the catherization laboratory with this new elastographic imaging technique. The prototype system was based on commercially available intravascular ultrasound (US) scanner that was equipped with a 20-MHz array catheter. Digital beam-formed radiofrequency (RF) echo data (i.e., 12 bits, 100 Hz) was captured at full frame rate from the scanner and transferred to personal computer (PC) memory using a fast data-acquisition system. Composite palpograms were created by applying a one-dimensional (1-D) echo tracking technique in combination with global motion compensation and multiframe averaging to several pairs of RF echo frames that were obtained in the diastolic phase of the cardiac cycle. The quality of palpograms was assessed by conducting experiments on vessel phantoms and on patients. The results demonstrated that robust and consistent palpograms could be generated in almost real-time using the proposed system. Good correlation was observed between low strain values and regions of calcification as identified from the intravascular US (IVUS) sonograms. Although the clinical results are clearly preliminary, it was concluded that the prototype system performed sufficiently well to warrant further and more in-depth clinical investigation.

Thresholds for detecting and characterizing focal lesions using steady-state MR elastography

An objective contrast-detail analysis was performed in this study to assess the low contrast detectability of a clinical prototype harmonic magnetic resonance elastographic imaging system. Elastographic imaging was performed on gelatin phantoms containing spherical inclusions of varying size and modulus contrast. The results demonstrate that lesions as small as 5 mm can be detected with a minimum modulus contrast of 14 dB. However, the shear modulus of such small lesions was not accurately recovered. In general, the shear modulus of larger focal lesions was accurately (i.e., within 25% of the true value) recovered. The minimum modulus contrast needed to detect focal lesions was observed to decrease with increasing lesion size.